Analysis of influencing factors of delayed facial paralysis after retrosigmoid approach surgery for vestibular schwannoma

Abstract

Objective To summarize the characteristics of delayed facial paralysis (DFP) after retrosigmoid approach surgery for vestibular schwannoma and screen its related influencing factors. Methods A total of 171 patients with vestibular schwannoma treated in The First Affiliated Hospital of Zhengzhou University from January 2019 to May 2021 were included in the study. All patients underwent retrosigmoid approach surgery under neuroelectrophysiological monitoring. Before and after the surgery, facial paralysis was classified according to House⁃Brackmann (H⁃B) grade of facial nerve function. Univariate and multivariate forward Logistic regression analysis was used to screen related risk factors of DFP after vestibular schwannoma surgery. Results Patients were divided into DFP group (n=19) and non⁃DFP (NDFP) group (n=152) according to whether there was DFP after surgery. The tumor diameter in DFP group was smaller than that in NDFP group (t=6.623, P=0.001), the proportion of small tumors (χ2=18.585, P=0.000) and the proportion of slight adhesion between tumor and facial nerve (χ2=21.442, P=0.000) were higher than those in NDFP group. Logistic regression analysis showed small tumor (OR=15.797, 95%CI: 3.324-75.081; P=0.001) and slight adhesion between tumor and facial nerve (OR=11.690, 95%CI: 3.413-40.042; P=0.000) were risk factors for DFP after vestibular schwannoma surgery. Following up to one year after surgery, the recovery rate of facial nerve function (H⁃B grade Ⅰ-Ⅱ) in DFP group was 17/19. Conclusions The patients with small tumor volume and slight adhesion between tumor and facial nerve are prone to DFP, and the prognosis of facial nerve function in such patients is good.

Keywords

• neuroma
• acoustic
• microsurgery
• facial paralysis
• postoperative complications
• risk factors
• logistic models