Analysis of the Social-Demographic, Endogenous and Exogenous Factors’ Influence on the Facial Nerve Intraoperative Neuropathy Recovery Process Following the Cerebellopontine Angle Tumors Removal

ABSTRACT

Background: Surgical treatment of cerebellopontine angle (CPA) tumors is the removal of the neoplasm by various methods. The most frequent intraoperative complication is damage to the facial nerve, which is due to the corresponding topography of the nerve. The reinnervation process does not always provide the necessary result, which motivated the search for new methods of treatment and optimization of postoperative management in patients with such problems in order to increase the effectiveness of the treatment of iatrogenic neuropathy of the facial nerve.

Aim: The aim of this cross-sectional prospective study is to analyze the impact of sociodemographic, endogenous, and exogenous factors on the process of facial nerve regeneration and its effectiveness after intraoperative facial nerve injury in patients with CPA neoplasms.

Materials and Methods: Depending on the treatment performed, the selected participants were randomized into 3 groups. The first group (n=44) consisted of patients who underwent standard postoperative treatment after reinnervation, the second (n=41) included patients in whom standard postoperative treatment after reinnervation was combined with local neurostimulation intervention, and the third group (n=42) patients received combined therapy using standard, neurostimulation, and pharmacological intervention. Participants were randomly assigned to clinical groups.

Results: Socio-demographic characteristics had a certain effect on the efficacy of restoring the functional activity of the facial nerve only in patients of groups 1 and 2. In group 3, such an assoication, except for the employment factor, was absent. In all three groups, the presence of type 2 diabetes mellitus, obesity, atherosclerosis, as well as the period of reinnervation after injury had a pronounced associative relationship with the result of reinnervation. In patients of group 2, the factor of tumorectomy volume also had a pronounced impact on the recovery period. Positive dynamics of facial nerve recovery was recorded in patients of groups 1 and 2 in case of complete and subtotal removal of the tumor. In group 1, the number of factors influencing the postoperative course was the highest: in addition to the above-mentioned indicators, the general index of the presence of concomitant diseases and arrhythmia were also influencing factors. Meanwhile, in patients of group 3, only atherosclerosis, obesity, type 2 diabetes mellitus and the period of reinnervation after injury acted as influencing factors. A pronounced correlative dependence between the positive result of reinnervation and reinnervation performed within 1-6 months after injury was observed in all clinical groups.

Conclusion: This study is the first to investigate the combined electrostimulation and drug therapy in order to reduce the influence of sociodemographic and clinical factors on the efficacy of treatment of iatrogenic neuropathy of the facial nerve. This opens new perspectives for studying the clinical effectiveness of the combined therapy by evaluating the recovery of the facial nerve according to functional activity scales and electroneuromyographic data. The results of the conducted research are an indirect confirmation of the effectiveness of the combined electrostimulation and drug treatment implemented by the author.