Abstract
ObjectiveThe facial nerve (FN) outcomes after vestibular schwannoma surgery seriously affect the social psychology and quality of life of patients. More and more attention has been paid to the protection of FN function. This study aimed to identify significant prognostic factors for FN outcomes after vestibular schwannoma surgery and create a new nomogram for predicting the rates of poor FN outcomes.MethodsData from patients who had undergone operations for vestibular schwannoma between 2015 and 2020 were retrieved retrospectively and patients were divided into good and poor FN outcomes groups according to postoperative nerve function. The nomogram for predicting the risk of poor FN outcomes was constructed from the results of the univariate logistic regression analysis and the multivariate logistic regression analysis of the influencing factors for FN outcomes after surgical resection of vestibular schwannoma.ResultsA total of 392 participants were enrolled. The univariate logistic regression analysis revealed that age, tumor size, cystic features of tumors, cerebrospinal fluid (CSF) cleft sign, tumor adhesion to the nerve, learning curve, and FN position were statistically significant. The multivariate logistic regression analysis showed that age, tumor size, cystic features of tumors, CSF cleft sign, tumor adhesion to the nerve, learning curve, and FN position were independent factors. The nomogram model was constructed according to these indicators. At the last follow-up examination, a good FN outcome was observed in 342 patients (87.2%) and only 50 patients (12.8%) was presented with poor FN function. Application of the nomogram in the validation cohort still gave good discrimination [area under the curve (AUC), 0.806 (95% CI, 0.752–0.861)] and good calibration.ConclusionThis study has presented a reliable and valuable nomogram that can accurately predict the occurrence of poor FN outcomes after surgery in patients. This tool is easy to use and could assist doctors in establishing clinical decision-making for individual patients.
Highlights
Vestibular schwannoma (VS) is the most common tumor in the cerebellopontine angle (CPA) and constitutes about 6% of all the intracranial tumors [1]
Significant differences were found between the 2 groups in age, tumor size, cystic features of tumors, cerebrospinal fluid (CSF) cleft surrounding the tumor, learning curve, and facial nerve (FN) position (p < 0.05; Table 2)
Variable assignment classification was used for the categorical variables and their assignment was either no and weak, indicated by 0, or yes and strong, indicated by 1
Summary
Vestibular schwannoma (VS) is the most common tumor in the cerebellopontine angle (CPA) and constitutes about 6% of all the intracranial tumors [1]. Since VS is histologically benign, a small asymptomatic tumor is usually treated with conservative strategy by “watchful waiting” [2, 3]. Surgery is still recommended for symptomatic and growing tumors [4]. Because the operation of VS is not usually life-threatening, effective prevention of facial nerve (FN) function is critical in clinical practice. Many factors have been associated with FN outcomes after surgery. It has been suggested that age, tumor size, and FN position all can impact ultimate facial functional outcomes [5, 6]. Some authors reported cystic features of the tumors association with worse outcomes [7], whereas others showed that there is no difference between cystic and solid tumors in terms of FN function after surgery [8]. To the best of our knowledge, no established method allows precise prediction of FN outcomes [9]
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