Clinical analysis of transcranial facial nerve bridging with interpositional graft for the treatment of facial nerve injury
-
摘要: 目的 通过回顾性研究对于接受跨颅内外面神经桥接吻合术的患者的面神经功能损伤治疗的效果进行分析。方法 对复旦大学附属眼耳鼻喉科医院2017至2022年进行了跨颅内外面神经吻合术的27例面神经功能损伤患者进行回顾性分析。主要收集的数据包括患者的年龄、性别、原发性病变、损伤位置、面瘫到手术的间隔时间以及术前和术后的面神经功能House-Brackmann(HB)评分, 并对患者术前术后的平均HB评分进行了统计学比较。结果 27例患者中男17例, 女10例; 手术时的平均年龄为(42.50±3.38)岁; 原发侧颅底疾病包括外伤3例、肿瘤22例和感染2例; 面瘫的持续时间6个月~5年。统计发现进行了跨颅内外面神经吻合术的患者的术后平均HB评分(3.750±0.183)较术前(4.875±0.168)明显下降。面神经功能良好患者比例从术前的7.4%上升到42.9%。结论 面神经跨颅内外端端吻合术后对于改善的面神经损伤患者的面神经功能都有显著效果。目前仍需要进一步的研究来评估该手术的长期效果, 并确定最佳的患者选择标准和术后康复策略。Abstract: Objective To retrospectively analyze the effectiveness of transcranial facial nerve bridging in the treatment of facial nerve dysfunction.Methods A retrospective analysis was conducted on 27 patients with facial nerve dysfunction who underwent transcranial facial nerve bridging at the Eye, Ear, Nose, and Throat Hospital affiliated with Fudan University from 2017 to 2022. The main collected data includes the patient's age, gender, primary lesion, damaged location, interval from facial paralysis to surgery, and preoperative and postoperative House-Brackmann(HB) scale for facial nerve function. Statistical comparisons were made between the average HB level of patients before and after surgery.Results A total of 27 patients included 17 males and 10 females. The average age of patients during surgery is(42.50±3.38) years old. Primary lateral skull base diseases include trauma(n=3), tumors(n=22), and infections(n=2). The duration of facial paralysis varies from 6 months to 5 years. Statistics analysis has found that the average postoperative HB score of patients who underwent transcranial facial nerve bridging was significantly lower at(3.750± 0.183) compared to preoperative(4.875±0.168). The proportion of patients with good facial nerve function increased significantly from 7.4% before surgery to 42.9% after surgery.Conclusion Transcranial facial nerve bridging surgery with interpositional graft has a significant effect on improving facial nerve function in patients with facial nerve injury. Further research is still needed to evaluate the long-term effectiveness of this surgery, to determine the optimal patient selection criteria and postoperative rehabilitation strategies.
-
-
表 1 接受跨颅内外面神经桥接吻合术的患者的基本特征和临床效果
序号 年龄/岁 性别 损伤位置 原发疾病 移植神经 术前HB评分 术后HB评分 1 47 男 左侧岩锥前上缘、面神经膝部、鼓室段、乳突段 外伤 耳大神经 Ⅳ Ⅲ 2 49 男 左侧岩锥、乳突区、鼓室鼓窦 肿瘤 耳大神经 Ⅳ Ⅲ 3 26 男 左侧内听道、膝状神经节、面神经第二段 肿瘤 腓肠神经 Ⅲ Ⅱ 4 58 男 左侧鼓室段及乳突段 肿瘤 耳大神经 Ⅴ Ⅳ 5 31 女 右侧面神经垂直段，鼓室段至颞外段 肿瘤 耳大神经 Ⅵ Ⅳ 6 32 女 右侧面神经垂直段，鼓室段至颞外段 肿瘤 耳大神经 Ⅵ Ⅴ 7 50 男 右侧锥曲段 肿瘤 耳大神经 Ⅴ Ⅳ 8 32 男 右侧水平段、锥曲段和垂直段 肿瘤 腓肠神经 Ⅴ Ⅳ 9 22 女 右侧膝状神经节、水平段、锥曲段和迷路段 肿瘤 腓肠神经 Ⅳ Ⅲ 10 39 男 左侧膝状神经节、鼓室段、鼓室和迷路段 肿瘤 耳大神经 Ⅳ Ⅳ 11 20 女 左侧岩锥前上缘、面神经膝部、鼓室段、乳突段 肿瘤 耳大神经 Ⅴ Ⅲ 12 63 男 右侧锥曲段至腮腺段、颈静脉孔 肿瘤 耳大神经 Ⅴ Ⅲ 13 50 男 右侧膝状窝、鼓室段 感染 耳大神经 Ⅴ Ⅴ 14 45 男 左侧中颅底、膝状神经节周围 肿瘤 耳大神经 Ⅵ Ⅳ 15 48 女 右侧膝管、鼓室段、降段 肿瘤 耳大神经 Ⅴ Ⅲ 16 36 女 右侧膝状神经节、迷路段、水平段 肿瘤 耳大神经 Ⅴ Ⅲ 17 38 男 右侧面神经锥曲段，乳突段、颈静脉球，下达腮腺总干 外伤 耳大神经 Ⅳ Ⅲ 18 32 男 右侧锥曲段+部分水平段 肿瘤 腓肠神经 Ⅴ Ⅴ 19 58 女 右侧水平段，下端到腮腺，下向前围绕颈静脉球 肿瘤 耳大神经 Ⅵ Ⅵ 20 35 男 右侧面神经乳突段 感染 耳大神经 Ⅴ Ⅳ 21 63 男 右侧面神经锥曲段、乳突段 肿瘤 耳大神经 Ⅳ Ⅲ 22 55 男 左侧面神经鼓室段、乳突段、颅外段及部分腮腺内分支 肿瘤 腓肠神经 Ⅲ Ⅱ 23 45 女 左侧迷路段、膝状神经节、水平段和锥曲段 肿瘤 耳大神经 Ⅳ Ⅳ 24 34 男 右侧锥曲段至腮腺段、颈静脉孔 肿瘤 耳大神经 Ⅵ Ⅴ 25 36 男 左侧膝状神经节 肿瘤 耳大神经 Ⅵ Ⅴ 26 42 女 右侧乳突区，面神经管乳突段，茎乳孔区，鼓室 肿瘤 腓肠神经 Ⅴ Ⅳ 27 62 女 右侧鼓室段、水平段、锥曲段和膝状神经节 外伤 腓肠神经 Ⅴ Ⅳ 
下载: 导出CSV
-
[1] 熊颖, 梁茂金, 陈穗俊, 等. 32例面神经鞘瘤临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(12): 1089-1091. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2021.12.006
[2] Rink-Notzon S, Reuscher J, Nohroudi K, et al. Trigeminal Sensory Supply Is Essential for Motor Recovery after Facial Nerve Injury[J]. Int J Mol Sci, 2022, 23(23): 15101. doi: 10.3390/ijms232315101
[3] Mcrackan TR, Rivas A, Wanna GB, et al. Facial nerve outcomes in facial nerve schwannomas[J]. Otol Neurotol, 2012, 33(1): 78-82. doi: 10.1097/MAO.0b013e31823c8ef1
[4] Melvin TA, Limb CJ. Overview of facial paralysis: current concepts[J]. Facial Plast Surg, 2008, 24(2): 155-163. doi: 10.1055/s-2008-1075830
[5] Yamaki T, Morimoto S, Ohtaki M, et al. Intracranial facial nerve neurinoma: surgical strategy of tumor removal and functional reconstruction[J]. Surg Neurol, 1998, 49(5): 538-546. doi: 10.1016/S0090-3019(97)00025-6
[6] House JW, Brackmann DE. Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985, 93(2): 146-147. doi: 10.1177/019459988509300202
[7] Scaramella LF. Cross-face facial nerve anastomosis: historical notes[J]. Ear Nose Throat J, 1996, 75(6): 343-354. doi: 10.1177/014556139607500607
[8] 迟放鲁, 王正敏, 陈泽宇, 等. 面神经瘤的诊断与处理[J]. 中华耳鼻咽喉头颈外科杂志, 2006, 41(4): 262-265. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHEB200604007.htm
[9] Han JH, Suh MJ, Kim JW, et al. Facial reanimation using hypoglossal-facial nerve anastomosis after schwannoma removal[J]. Acta Otolaryngol, 2017, 137(1): 99-105. doi: 10.1080/00016489.2016.1212398
[10] Coombs CJ, Ek Ew, WU T, et al. Masseteric-facial nerve coaptation-an alternative technique for facial nerve reinnervation[J]. J Plast Reconstr Aesthet Surg, 2009, 62(12): 1580-1588. doi: 10.1016/j.bjps.2008.05.046
[11] Gao Z, Jia XH, Xu J, et al. Neurorrhaphy for Facial Reanimation with Interpositional Graft: Outcome in 23 Patients and the Impact of Timing on the Outcome[J]. World Neurosurg, 2019, 126: e688-e693. doi: 10.1016/j.wneu.2019.02.124
[12] Prasad SC, Balasubramanian K, Piccirillo E, et al. Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases[J]. J Neurosurg, 2018, 128(2): 631-638. doi: 10.3171/2016.9.JNS16997
[13] Novikova L, Novikov L, Kellerth JO. Effects of neurotransplants and BDNF on the survival and regeneration of injured adult spinal motoneurons[J]. Eur J Neurosci, 1997, 9(12): 2774-2777. doi: 10.1111/j.1460-9568.1997.tb01706.x
[14] Goldberg JL, Barres BA. The relationship between neuronal survival and regeneration[J]. Annu Rev Neurosci, 2000, 23: 579-612. doi: 10.1146/annurev.neuro.23.1.579
[15] Arriaga MA, Brackmann DE. Facial nerve repair techniques in cerebellopontine angle tumor surgery[J]. Am J Otol, 1992, 13(4): 356-359.
[16] Varelas AN, Varelas EA, Kay-rivesTE, et al. Facial Reanimation After Intratemporal Facial Nerve Schwannoma Resection: A Systematic Review[J]. Facial Plast Surg Aesthet Med, 2023. doi: 10.1089/fpsam.2023.0229.
-
计量
- 文章访问数: 133
- 施引文献: 0