摘要
目的探讨预变性自体腓肠神经移植桥接舌下神经－面神经＂侧＂－侧吻合术治疗小脑脑桥角（CPA）区肿瘤切除术后面神经损伤所致周围性面瘫的疗效。方法回顾性分析2013年6月至2016年2月首都医科大学附属北京天坛医院神经外科收治的48例CPA区肿瘤切除术后面瘫患者的临床资料。48例（试验组）均行预变性腓肠神经桥接舌下神经－面神经＂侧＂－侧吻合术治疗。同期纳入CPA区肿瘤术后行非手术治疗的8例患者（对照组）。术后两组均行康复锻炼治疗。采集两组患者的静态和动态面容图像，并进行面神经电生理检查（包括肌电图、运动神经传导以及F波情况）。采用House-Brackmann面神经功能分级方法（简称H-B分级）评估面神经的功能。随访时间为2～36个月，平均（12.1±13.4）个月。结果与吻合术前相比，试验组术后H-B分级明显改善24例，改善21例，无改善3例；对照组术后H-B分级明显改善1例，改善2例，无改善5例。两组H-B分级改善程度的差异有统计学意义（P〈0.01）。面瘫6个月内行腓肠神经预变性桥接舌下神经－面神经＂侧＂－侧吻合术，患者面神经功能改善效果最明显。结论预变性自体神经移植桥接舌下神经－面神经＂侧＂－侧吻合术可有效治疗CPA区肿瘤切除术后的周围性面瘫，面瘫6个月内实施吻合术效果较佳。
Objective To evaluate the treatment effects of hypoglossal-facial ＇side＇-to-side neurorrhaphy using a predegenerated sural nerve autograft for facial paralysis following tumor resection in cerebellopontine angle （CPA） area. Methods We followed up 48 patients who developed facial paralysis as a result of CPA tumor removal and underwent hypoglossal-facial ＇ side＇-to-side neurorrhaphy using a predegenerated sural nerve autograft between June 2013 to February 2016 at Neurosurgery Department of Beijing Tiantian Hospital, Capital Medical University. Eight other patients who served as controls did not receive any repair treatment. Patients in both groups received rehabilitation exercises and their static and dynamic facial images were collected. Electrophysiological tests of the facial nerve were conducted including electromyography, motor nerve conduction and F wave. The patients＂ facial nerve functions were assessed according to House-Brackmann grading scale （ H-B scale ）. The follow-up lasted 2 - 36 months with an average of （12.1 ＋ 13.4 ） months. Results In the surgical treatment group, 24/48 patients were found postoperatively to have significant facial function improvement on H-B scale, 21/48 patients to have improvement, and 3/48 remained unchanged. In the control group, 1/8 patient was found to have significant facial function improvement on H-B scale, 2/8 had improvement and 5/8 remained unchanged associated with marked atrophy of paralyzed facial muscles. Significant difference was identified in the facial function improvement on H-B scale between the surgical treatment and control groups （P 〈 0.01 ）. The improvement of facial nerve function was most evident if the surgical repair treatment was performed within the 6 months after the onset of facial paralysis. Conclusions Hypoglossal-facial ＇side＇-to-side neurorrhaphy may effectively treat facial paralysis resulting from CPA tumor resection. Better recovery of facial nerve function could be achieved when the surgical treatment is performed within the 6 months after the onset of the facial paralysis.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第6期564-568,共5页
Chinese Journal of Neurosurgery
基金
国家自然科学基金（81471239）
首都卫生发展科研专项项目（2014-2-1073）
关键词
中枢神经系统肿瘤
小脑脑桥角
面神经麻痹
移植
自体
“侧”一侧吻
合术
Central nervous system neoplasms
Cerebellopontine angle
Facial paralysis
Transplantation,autologous
＇ Side＇ -to-side neurorrhaphy
