sibneiroСибнейроSibneuro3033-649X3033-6805Bervitskiy Anatoliy Vladimirovich10.64265/sibneuro-2025-1-1-47-56sibneiro-20Research ArticleСтатьиАнатомическое повреждение лицевого нерва при удалении больших и гигантских вестибулярных шванномAnatomical injury of the facial nerve during removal of large and giant vestibular schwannomashttps://orcid.org/0000-0001-9390-3134РуденкоП. Г.RudenkoP. G.

Руденко Павел Геннадьевич – кандидат медицинских наук, доцент кафедры травматологии, ортопедии и нейрохирургии с курсом ПО, ФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Минздрава России; врач-нейрохирург КГБУЗ «Краевая клиническая больница»

ул. Партизана Железняка, д. 1, г. Красноярск, 660022 

ул. Партизана Железняка, д. 3а, г. Красноярск, 660022 

Pavel G. Rudenko – Cand. Sci. (Med.), Associate Professor of the Department of Traumatology, Orthopedics and Neurosurgery with a Course of Continuing Professional Education, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University; Neurosurgeon, Krasnoyarsk Regional Clinical Hospital 

Partizana Zheleznyaka str., 1, Krasnoyarsk, 660022 

rpg30@rambler.ruhttps://orcid.org/0000-0003-4554-5306КанашинА. В.KanashinA. V.

Канашин Александр Васильевич – врач-нейрохирург 

ул. Партизана Железняка, д. 3а, г. Красноярск, 660022 

Alexander V. Kanashin – Neurosurgeon 

Partizana Zheleznyaka str., 3A, Krasnoyarsk, 660022 

aleksander.kanashin2017@yandex.ruhttps://orcid.org/0000-0003-3889-1956КобаненкоВ. О.KobanenkoV. O/

Кобаненко Владислав Олегович – младший научный сотрудник 

ул. Партизана Железняка, д. 1, г. Красноярск, 660022 

Vladislav O. Kobanenko – Junior Researcher, Professor

Partizana Zheleznyaka str., 1, Krasnoyarsk, 660022  

kobanenko1999@bk.ruhttps://orcid.org/0000-0001-8738-6847ФайзоваМ. Н.FayzovaM. N.

Файзова Марворид Нусратуллоевна – врач-нейрохирург 

ул. Партизана Железняка, д. 1, г. Красноярск, 660022 

Madina N. Fayzova – Neurosurgeon, Professor  

Partizana Zheleznyaka str., 1, Krasnoyarsk, 660022 

marvoridin00@gmail.comФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Минздрава России; КГБУЗ «Краевая клиническая больница»Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University;КГБУЗ «Краевая клиническая больница»Krasnoyarsk Regional Clinical HospitalФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Минздрава РоссииProfessor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University202514102025114756Copyright © Руденко П.Г., Канашин А.В., Кобаненко В.О., Файзова М.Н., 20252025Руденко П.Г., Канашин А.В., Кобаненко В.О., Файзова М.Н.Rudenko P.G., Kanashin A.V., Kobanenko V.O., Fayzova M.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibneurojournal.com/jour/article/view/20

Удаление больших и гигантских вестибулярных шванном остается одной из наиболее трудных задач в нейрохирургии. Вероятность анатомического повреждения лицевого нерва при удалении этих новообразований составляет 10,3–17 %.

Цель исследования

Цель исследования. Проанализировать частоту и факторы риска анатомического повреждения лицевого нерва во время удаления больших и гигантских вестибулярных шванном. Материал и методы. Обследовано 93 пациента с большими и гигантскими вестибулярными шванномами. Для определения факторов риска исследовались линейные и угловые параметры задней черепной ямки (ЗЧЯ), магнитно-резонансные характеристики опухоли, а также клинические и интраоперационные данные. Статистический анализ и обработку проводили с помощью программного пакета Statistica 10.0 for Windows (StatSoft Inc., США). Оценку статистической значимости проводили с использованием критериев Манна – Уитни, χ2-критерия Пирсона или точного критерия Фишера для категориальных данных.

Результаты

Результаты. Анатомическое повреждение лицевого нерва во время удаления опухоли было зафиксировано у 8 (8,6 %) пациентов. Длина ЗЧЯ была статистически значимо меньше, чем в группе сравнения: 73,3 и 78,8 мм соответственно (U = 491,0; p = 0,039). По результатам магнитно-резонансной томографии у пациентов основной группы чаще визуализировались перитуморозный отек (р = 0,345), гидроцефалия и перивентрикулярный отек (р = 0,204), а также отсутствовала ликворная щель (р = 0,426). По данным перфузионной мультиспиральной компьютерной томографии отмечался более высокий показатель мозгового кровотока в ткани опухоли (p = 0,800). Статистической значимости выявленные отличия не имели. Из интраоперационных факторов риска следует отметить радикальность удаления опухоли. В основной группе все опухоли были удалены радикально, в то время как в группе сравнения процент радикально резецированных шванном составил лишь 62,3 % (p = 0,047).

Заключение

Заключение. Кроме хорошо известных факторов, приводящих к увеличению риска интраоперационного повреждения нерва, нами выявлено и влияние анатомических особенностей строения задней черепной ямки. Данное осложнение чаще происходит у пациентов с узкой и короткой формой ямки. Вероятность анатомического повреждения лицевого нерва при радикальном удалении больших и гигантских вестибулярных шванном статистически значимо выше в сравнении с субтотальным.

The removal of large and giant vestibular schwannomas remains one of the most challenging tasks in neurosurgery. The probability of anatomical injury to the facial nerve during the removal of these neoplasms is 10.3–17%. Objective of the article was to analyze the frequency and risk factors for anatomical injury of the facial nerve during the removal of large and giant vestibular schwannomas.

Materials and methods

Materials and methods. A total of 93 patients were examined. To determine risk factors, linear and angular parameters of the posterior cranial fossa, magnetic resonance characteristics of the tumor, as well as clinical and intraoperative data were investigated. Statistical analysis was performed using the Statistica software package (version 10.0) for Windows (StatSoft, USA). Statistical significance was assessed using the Mann – Whitney U test, Pearson’s χ2 test, or Fisher’s exact test for categorical data.

Results

Results. Anatomical injury to the facial nerve during tumor removal was recorded in 8 patients, accounting for 8.6%. The length of the posterior cranial fossa was statistically significantly smaller than in the comparison group: 73.3 mm and 78.8 mm, respectively (U = 491.0, p = 0.039). The width of the posterior cranial fossa was also smaller but without statistical significance: 108.8 mm and 113.3 mm, respectively (U = 433.0, p = 0.205). According to MRI results, patients in the main group more frequently exhibited peritumoral edema (p = 0.345), hydrocephalus and periventricular edema (p = 0.204), and absence of a cerebrospinal fluid (CSF) cleft (p = 0.426). According to CT perfusion data, a higher CBF (cerebral blood flow) index was noted in the tumor tissue (p = 0.800). The identified differences were not statistically significant. Among intraoperative risk factors, the radicality of tumor removal should be noted. In the main group, all tumors were removed radically, while in the comparison group, the percentage of radically resected schwannomas was only 62.3% (p = 0.047).

Conclusion

Conclusion. In addition to well-known factors leading to an increased risk of intraoperative nerve injury, we also identified the influence of anatomical features of the posterior cranial fossa structure. This complication occurs more often in patients with a narrow and short fossa. The probability of anatomical injury to the facial nerve during radical removal of large and giant vestibular schwannomas is statistically significantly higher compared to subtotal removal.

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The authors declare that there are no conflicts of interest present.