颞骨内肿瘤相关周围性面瘫的手术疗效观察  

Observation of surgical therapeutic effect of peripheral facial paralysis associated with intratemporal tumor

作　　者：张幸楠 栗伟杰 凌苗 黎震 王彬彬[1] 孙圣乔 郭超 李德志[2] 刘松[1,2] Zhang Xingnan;Li Weijie;Ling Miao;Li Zhen;Wang Binbin;Sun Shengqiao;Guo Chao;Li Dezhi;Liu Song(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《中华神经外科杂志》2022年第5期466-470,共5页Chinese Journal of Neurosurgery

基　　金：北京市卫生健康委员会项目(PXM2020_026280_000002)。

摘　　要：目的探讨颞骨内肿瘤相关周围性面瘫的手术疗效。方法回顾性分析2017年9月至2020年9月于首都医科大学附属北京天坛医院神经外科行肿瘤切除同期联合面神经修复术治疗的颞骨内肿瘤相关性面瘫患者的临床资料,共17例;面瘫时间为6个月至10年(中位时间为2年)。观察肿瘤的切除情况、手术并发症,随访肿瘤的复发情况;采用面神经功能House-Brackmann(H-B)分级和面神经针极肌电图评估面神经的改善情况。结果17例患者均全切除肿瘤并行面神经修复。术后3例发生脑脊液漏,经治疗后均治愈;术后3~6个月MRI检查均未见肿瘤复发。术前H-B分级Ⅵ级8例、Ⅴ级7例、Ⅳ级2例;术后3~6个月,面神经功能均恶化,其中H-B分级Ⅵ级11例、Ⅴ级6例;术后9~12个月,除2例面神经功能H-B分级Ⅵ级者较术前无改善外,其余患者面神经功能均改善,其中H-B分级Ⅴ级2例、Ⅳ级9例、Ⅲ级4例。术后24个月随访的12例患者中,H-B分级Ⅴ级2例,Ⅳ级、Ⅲ级各3例,Ⅱ级4例。术后9~12个月,行针极肌电图检查的8例患者,口轮匝肌7例改善,1例无改善;额肌5例改善,3例无改善;眼轮匝肌3例改善,4例无改善,1例恶化。结论肿瘤切除同期联合面神经修复术治疗颞骨内肿瘤相关性面瘫的效果较好,面神经修复术后多数患者的面神经功能改善,其中口轮匝肌改善效果最好,眼轮匝肌最差。Objective To investigate the surgical efficacy of intratemporal tumor-related peripheral facial paralysis(PFP).Methods We retrospectively analyzed the clinical data of patients with intratemporal tumor-related PFP who underwent tumor resection combined with facial nerve repair at the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from September 2017 to September 2020,and a total of 17 cases were enrolled.Facial paralysis lasted from 6 months to 10 years(median time was 2 years).Tumor resection and surgical complications were documented,and tumor recurrence was followed up.The improvement of the facial nerve function was assessed by House-Brackmann grading system(H-B grade)and facial nerve needle electrode electromyography(EMG).Results All 17 patients underwent total resection of tumor and facial nerve repair.Cerebrospinal fluid leakage occurred in 3 patients after operation,and no tumor recurrence was indicated on MRI examination at 3 to 6 months post operation.There were 8 cases of preoperative H-B gradeⅥ,7 cases of gradeⅤ,and 2 cases of gradeⅣ.At 3 to 6 months after surgery,the facial nerve function deteriorated,including 11 cases of H-B gradeⅥ,and 6 cases ofⅤ.At 9 to 12 months after surgery,facial nerve function was improved in all patients expect 2 patients with H-B gradeⅥ,who included 2 patients with H-B gradeⅤ,9 patients with H-B gradeⅣand 4 patients with H-B gradeⅢ.Among the 12 patients followed up 24 months after surgery,2 patients were classified as H-B gradeⅤ,3 patients as gradeⅣ,3 patients as gradeⅢ,and 4 patients as gradeⅡ.After 9-12 months,the orbicularis oris muscle function was improved in 7 cases and not improved in 1 case among 8 patients who underwent EMG.Frontal muscle function was improved in 5 cases and not improved in 3 cases.The orbicularis oculi muscle function was improved in 3 cases,not improved in 4 cases,and deteriorated in 1 case.Conclusions The surgical outcome of intratemporal tumor-related PFP seems relatively favorable,and

关 键 词：颞骨 肿瘤 神经外科手术 面神经修复 

分 类 号：R738.1[医药卫生—肿瘤] R745.12[医药卫生—临床医学]