ORIGINAL
Introdução: Schwannomas vestibulares são lesões intracranianas expansivas, localizadas na cisterna cerebelar pontina, sendo o tumor mais comum nessa região. O primeiro manejo neurocirúrgico foi em 1894. As técnicas cirúrgicas foram modificadas e evoluíram desde então. Os schwannomas vestibulares gigantes, no entanto, mantêm-se como um desafio terapêutico. Objetivo: Analisar possíveis fatores perioperatórios relacionados à função do nervo facial no pós-operatório de pacientes submetidos à cirurgia para schwannomas vestibulares gigantes. Métodos: Um estudo retrospectivo e observacional foi desenhado para avaliação de tumores do ângulo cerebelopontino de 2018 a 2020. Foram selecionados 21 pacientes. A análise da função do nervo facial foi estudada em 3 períodos: pré-operatório, pós-operatório imediato e pós-operatório tardio. Também foram realizadas análises das variáveis transoperatórias e pós-operatórias. Resultados: Função facial boa/excelente esteve presente em 80,9% após 1 ano de cirurgia. A posição posterior do nervo facial e a necessidade de drogas vasoativas por 48 horas foram os grupos que mostraram significância estatística para a perda da função do nervo facial. Conclusão: Estes resultados reforçam a segurança do tratamento cirúrgico, bem como a preservação da função do nervo facial, exigindo observação do uso de drogas vasoativas e avaliação da perda sanguínea, bem como a posição do nervo facial durante a cirurgia.
Introduction: Vestibular Schwannomas are expansive intracranial lesions localized in the pontine cerebellar cistern, being the most common tumor in this region. The first neurosurgical management was in 1894. Surgical techniques were modified and had evolved since then. Giant Vestibular Schwannomas, however, stands as a therapeutic challenge. Objective: To analyze possible perioperative factors related to facial nerve function in the postoperative period of patients undergoing surgery for Giant Vestibular Schwannomas. Methods: A retrospective and observational study was designed to evaluate the cerebellopontine angle tumors from 2018 to 2020. Twenty one patients were selected. The analysis of facial nerve function was studied in 3 periods: preoperative, immediate postoperative, and late postoperative. Analysis of transoperative and postoperative variables were also performed. Results: Good/excellent facial function was present in 80.9% after 1 year of surgery. The posterior position of the facial nerve and the need for vasoactive drugs for 48 hours were the groups showing statistical significance for losing facial nerve function. Conclusion: These results reinforce the safety of surgical treatment as well as the preservation of Facial Nerve function, requiring observation of the use of vasoactive drugs and assessment of blood loss, as well as the position of the facial nerve during surgery.
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1 MD, Neurosurgeon, Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza (CE), Brazil.
2 MD, Neurosurgeon, Head of the Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza (CE), Brazil.
Received Dec 7, 2022
Accepted Dec 28, 2022
