[Functional results of the surgery of unilateral acoustic neuroma].
The authors sent a circumstantial questionnaire to 224 surviving patients out of a 228 unilateral acoustic neurinoma operated on from June 83 to December 90 range of patients in order to assess their complaints. Seventy-two per cent of these neurinomas were Stade III or IV of Koos. Translabyrhintine approach was used for 85% and suprapetrous approach for 15%. The post-operative mortality rate is 1.75%. At the end of the procedure, the removal seemed total in 99% of cases and the anatomical facial nerve continuity was preserved in 94% of cases. Our patients kept or recovered a normal (Grade I of House--52%) or almost normal (Grade II of House--14%) facial motion in 66% of cases. A normal facial rest stretching with a complete eyelid closure but an asymmetrical facial mimic (Grade III of House) were in 20% of cases, and a more important facial palsy with incomplete eyelid closure was in 4% of cases (Grade IV of House). Patients needed an hypoglosso-facial anastomosis in 10% of cases. Always, this anastomosis restored a good facial motion near the Grade III of House. Hearing preservation was achieved for 45% of the attempts (through a suprapetrous approach) but hearing so preserved was functional (pure tone loss less than 50 db) in 37.5% of cases (5% of all the patients of this series) and only 61% of these patients kept or recovered a normal or almost normal facial motion. Varying, often regressive, complications were observed: C.S.F. leakages (7.5%) through the operative wound in two third of cases, owing to a pressure raising due to meningitis or C.S.F. circulatory constraint and usually cured by lumbar punctures and, if need be, antibiotics and, in one third of cases, through the tympanic cavity then nostril because of a hole remaining on the petrous drilled wall and usually needing a reintervention, swallowing difficulties (3%), due to a contralateral vagus nerve palsy in half of cases, postoperative hematomas (1.75%), fatal in one out of two times, brain traumatism (1.75%), meningitis (0.4%). The answers of patients were proper enough to be used for this study in 80% of cases (178). Their subjective answers about facial motion agreed with our objective assessment in 84% of cases that is emphasizing the difficulties of all attempt to this type of valuation. Our patients point out balance troubles in 67% of cases.(ABSTRACT TRUNCATED AT 400 WORDS)
Service de Neurochirurgie, Hôpital Sainte-Marguerite, Marseille.
W
W
Pellet
B
B
Emram
M
M
Cannoni
A
A
Pech
M
M
Zanaret
M
M
Thomassin
D000293:Adolescent; D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D005155:Facial Nerve Diseases / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D011183:Postoperative Complications; D011795:Surveys and Questionnaires