Vestibüler Schwannoma Cerrahisi Sonrası Fasiyal Parezisi Gelişen Hastalarda Fizyoterapinin Etkinliğinin Değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı, Vestibüler schwannoma (VS) cerrahisi sonrası fasiyal fonksiyon kaybı gelişen hastalarda erken dönemde uygulanan fizyoterapinin etkinliğini değerlendirmektir.

Yöntem: 2015-2018 yılları arasında retrosigmoid girişim ile tama yakın VS rezeksiyonu uygulanan hastalar retrospektif olarak incelendi. Hastaların demografik bilgileri, nörolojik muayene bulguları ve histopatolojik inceleme raporları tıbbı kayıt sisteminden elde edildi. Fasiyal sinir hasarı değerlendirmesi House–Brackmann derecelendirme ölçeği kullanılarak tanımlandı. Tüm hastalara postoperatif erken dönemde mimik kaslarında hiperemi oluşturmaya ve kas tonusunun korunmasına yönelik masaj uygulaması yapıldı. Bozulan sinir iletiminin elektriksel olarak uyarılması ve kas kitlesinin korunması için elektrik stimülasyonu uygulandı. Ayrıca günde 5 er dakika, 3 mhz frekansında ultrasound uygulaması yapıldı. Ameliyat sonrası tüm hastalar 1,3, 6 ay klinik muayene ve 3. ayda kontrol MRG ile düzenli olarak takip edildi. 

Bulgular: Hastaların postoperatif erken dönem fasiyal sinir fonksiyonu 2.9 (aralık: 2-5) idi ve 1. ay, 3. ay ve 6. ay kontrollerinde ortalama fasiyal sinir fonksiyonu sırasıyla 2.3 (aralık: 1-4), 2.1 (aralık: 1-4) ve 1.8 (aralık: 1-4) idi. Vestibüler schwannoma rezeksiyonu sonrası fasiyal paralizi gelişen hastalarda postoperatif erken dönem ve 6. ay kontrol fasiyal sinir fonksiyonları karşılaştırıldığında istatiksel olarak anlamlı derecede iyileşme olduğu görülmüştür. (p=0.001)

Sonuç: Çalışmamızın sonuçları, erken dönem fizyoterapi ile VS rezeksiyonu sonrası gelişen fasiyal sinir fonksiyon kayıpların geri kazanılmasında etkin olduğunu göstermektedir.

Keywords

• Vestibüler Schwannoma,fasiyal parezi,fizyoterapi

Evaluation of the Efficacy of Physiotherapy in Patients with Facial Paresis after Vestibular Schwannoma Surgery

Abstract

Aim: The aim of this study was to evaluate the efficacy of early physiotherapy in patients with facial dysfunction after vestibular schwannoma (VS) surgery.

Methods: The patients who underwent a gross total VS resection by retrosigmoid procedure between 2015-2018 were retrospectively evaluated. Demographic data, neurological examination findings, and histopathological examination reports were obtained from the medical registry. The facial nerve injury was assessed using the House – Brackmann rating scale. All patients underwent massage in the early postoperative period to induce hyperemia in the mimic muscles and to preserve muscle tone. Electrical stimulation was applied to electrical stimulation of impaired nerve conduction and to preserve muscle mass. In addition, 5 minutes per day, 3 MHz frequency ultrasound was applied. Postoperatively, all patients were followed up by clinical examination at 1.3, 6 months, and control MRI at 3 months. 

Results: Early postoperative facial nerve function of the patients was 2.9 (range: 2-5) and the mean facial nerve function was 2.3 (range: 1-4), 2.1 (range: 1) and 1.8 (range: 1-4) at the 1st month, 3rd month and 6th month controls, respectively. In patients who developed facial paralysis after vestibular schwannoma resection, early postoperative and 6th month control facial nerve functions were significantly improved (p = 0.001).

Conclusion: The results of our study show that it is effective in recovering facial nerve function losses after VS resection with early physiotherapy.

Keywords

• Vestibular schwannoma,facial nerve paralysis,physiotherapy

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