Результаты хирургического лечения пациентов с нейрогенными опухолями лицевого нерва интратемпоральной локализации

Abstract

Objectives. To describe surgical outcomes of neurogenic facial nerve tumors (NFNT). Patients and methods. The study included 18 patients with intratemporal NFNT, 12 women and 6 men. The average age was 41,4 ± 18,9 years (range from 3 to 66 years). To assess the facial nerve (FN) function, a 6-step House–Brackmann scale was used. Tumors were removed mainly by the transmastoid route. The translabyrinthine approach was performed in the case of a labyrinth segment of the FN involved. Two patients underwent a combined transmastoid-middle fossa approach in the case of tumor spreading into the middle cranial fossa. Facial nerve reconstruction performed by end-to-end neurorrhaphy or with the sural nerve autograft in the case of a nerve deficiency. Recurrence or continued tumor growth was monitored by contrast-enhanced MRI at the last visit. Results. The most common tumor lesions were the mastoidal (66,7%) and tympanic (55,6%) segments of the FN. Multiple-segment involvement was in 10 cases (55,6%). All patients were admitted for surgical treatment with signs of paresis of mimic muscles of II–VI degree. Improvement of the FN function was achieved in 10 patients (55,6%), in 5 cases with n.suralis autograft. In 6 cases (33,3%), the FN function remained to the preoperative level, in 3 of them, with the use of an autograft. The FN function downgraded in 2 cases (11,1%) without FN reconstruction. Recurrence or continued growth of the residual tumor was detected in 2 patients (11,1%). Hearing improvement was achieved in 12 cases (66,7%), hearing decrease was obtained in 2 cases (11,1%), in 4 cases hearing remained at the preoperative level (22,2%). Conclusion. Surgical approach should be adequate to the spread of the tumor process and consider the possibility of hearing preservation. When the geniculate node and the labyrinth segment of the FN are involved, it is advisable to use access through the middle cranial fossa with socially adequate hearing. Timely and adequate surgical treatment allows maintaining or improving the function of the facial nerve in most cases (88,9%).