Cirugía del schwannoma vestibular. Factores predisponentes y predictores de parálisis facial.

Resumen

Introducción y objetivo: La parálisis facial es una de las posibles complicaciones que pueden aparecer tras la cirugía del schwannoma vestibular. Nuestro objetivo es identificar los posibles factores perioperatorios que puedan predecir la aparición de esta complicación. Método: Se lleva a cabo un estudio retrospectivo en 291 pacientes diagnosticados de schwannoma vestibular entre 1995 y 2017 en el servicio de Otorrinolaringología y Cirugía Cervicofacial del Hospital Clínico Universitario de Salamanca, analizándose diferentes datos pre y postoperatorias de los pacientes, así como hallazgos radiológicos y quirúrgicos. Resultados: Del total de pacientes operados y que completan el seguimiento (N=140), no presentan parálisis facial (PF) a los 7 días (grado I) un 44.4%, 6.8% son grado II, 3.8% grado III, 8.3% grado IV, 10.5% grado V, 26.3% grado VI. A los 6 meses un 51.9% tiene grado I, un 11.1% presenta un grado II, 10.4% un grado III, 7.4% un grado IV, 8.1% un grado V y 11.1% un grado VI. Es decir, tras 6 meses desde la operación, presenta PF (grado II) un 48.1 % de pacientes y presentan una buena función del nervio facial (grados I-III [15]) 70,4 % pacientes. Las variables significativas que asociamos a la PF son grados de tumor III-IV, cirugía retrosigmoidea, exéresis completa, estudio electrofisiológico del nervio facial (EEF) alterado, no preservación de la audición y videonistagmografía (VNG) patológica. Discusión y conclusiones: el factor más predictivo, en cuanto a la aparición de PF, es el tamaño del tumor siendo otro factor predictivo importante el tipo de cirugía que se va a realizar. Otros factores son la totalidad de la extirpación, un registro anómalo (axonotmesis o neurotmesis) en el EEF y el déficit canalicular determinada por VNG entre 76-100% y entre 25-75%.
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