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Khirurgii

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Year 2020 Vol. 28 No 3

NEUROSURGERY

IA.V. TSYMBALIUK 1, V.I. TSYMBALIUK 1, 2, I.B. TRETYAK 1, V.V. MEDVEDIEV 2, V.G. GURIANOV 2, A.A. GATSKIY 1, T.I. PETRIV 1

COMPARATIVE ANALYSIS OF VARIOUS TYPES OF NEUROTIZATION AS A METHOD OF SURGICAL TREATMENT OF PERIPHERAL FACIAL PARESIS

Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine 1
National Medical University Named after A.A. Bogomolets 2, Êiev,
Ukraine

Objective. Determination of the optimal type of facial nerve neurotization in patients with the consequences of its traumatic injury.
Methods. The treatment results of patient (n=172) with the facial nerve injury who underwent neurotization using different donor nerves was analized.
Women (n=97) made up 56.4%, men (n=75) – 43.6%. The median age was 38 years; the interquartile range was 29 – 50 years. The most common cause of the facial nerve damage was the removal of posterior fossa tumor – 123 patients (71.5%). Various types of reconstructive interventions were performed: facial nerve neurotization by the branches of the accessory nerve to the sternocleidomastoid muscle – 87 patients, facial nerve neurotization by branch of the accessory nerve to the sternocleidomastoid muscle and the descending branch of the hypoglossal nerve – 62 patients, by the accessory nerve – 10 patients, by the descending branch of the hypoglossal nerve – 10 patients, anterior motor branches C2-C3 – 3 patients.
The immediate and long-term results of treatment were studied. Patients underwent a follow-up examination and an ENMG study no earlier than 4 months after the surgery. Long-term results were studied no earlier than 12 months and up to 24 months after the surgery by means of repeated neurological examinations and additional electrophysiological techniques.
Results. In all cases, a positive result has been achieved. In 147 (85.4%) out of 172 patients, the recovery of facial nerve function according to the House – Brackmann scale to II – III level was observed. The best results were achieved in the cases of neurotization by the branches of the accessory nerve and the simultaneous use of several donor nerves (p<0.001).
Conclusion. The use of the accessory nerve branches as donors ensures restoration of the facial nerve function to level II-III on the House – Brackmann scale in 89.7% of patients and in terms of effectiveness, it does not differ from the technically more complex and prognostically less favorable facial nerve neurotization by the descending branch of the hypoglossal nerve and the branch of accessory nerve.

Keywords: neurotization, facial nerve, donor nerve, electroneuromyography, surgical treatment
p. 299-308 of the original issue
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Address for correspondence:
04050, Ukraine,
Êiev, Platon Mayboroda str., 32,
Institute of Neurosurgery Named
after A.P. Romodanov NAMS of Ukraine,
Department of Restorative Neurosurgery,
tel.: +38 (044) 483-12-53,
e-mail: yaroslav.neuro@gmail.com,
Tsymbaliuk Iaroslav V.
Information about the authors:
Tsymbaliuk Iaroslav V., Postgraduate Student of the Department of Neurosurgery, National Medical University Named after. A.A. Bogomolets, Neurosurgeon of the Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, Êiev, Ukraine.
http://orcid.org/0000-0002-8746-0944
Tsymbaliuk Vitalii I., Academician of NAMS of Ukraine, Corresponding Member of NAS of Ukraine, MD, Professor, President of NAMS of Ukraine, Head of the Department of Neurosurgery, National Medical University Named after A.A. Bogomolets, Scientific Supervisor of Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, Êiev, Ukraine.
http://orcid.org/0000-0003-3608-9679
Tretyak Igor B., MD, Head of Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, Êiev, Ukraine.
http://orcid.org/0000-0003-0977-7062
Medvediev Vladimir V., MD, Associate Professor of the Department of Neurosurgery, National Medical University Named after. A.A. Bogomolets, Êiev, Ukraine.
http://orcid.org/0000-0001-7236-3191
Gurianov Vitaly G., PhD, Associate Professor of the Department of Public Health Service Management, National Medical University Named after A.A. Bogomolets, Êiev, Ukraine.
https://orcid.org/0000-0001-8509-6301
Gatskiy Alexander A., PhD, Neurosurgeon of the Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, Êiev, Ukraine.
http://orcid.org/0000-0002-2212-2143
Petriv Taras I., PhD, Neurosurgeon of the Restorative Neurosurgery Department, Institute of Neurosurgery Named after A.P. Romodanov NAMS of Ukraine, Êiev, Ukraine.
http://orcid.org/0000-0001-9160-8908
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