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Liu J, Fan X, Yang L, Tao X, Jin Y, Li K, Yang J, Qiao H. Predictive value of Blink reflex and facial corticobulbar motor evoked potential in cerebellopontine angle tumor surgery. Clin Neurophysiol 2024; 162:165-173. [PMID: 38642482 DOI: 10.1016/j.clinph.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE The current study examined the efficacy of the facial corticobulbar motor evoked potentials (FCoMEPs) and blink reflex (BR) on predicting postoperative facial nerve function during cerebellopontine angle (CPA) tumor surgery. METHODS Data from 110 patients who underwent CPA tumor resection with intraoperative FCoMEPs and BR monitoring were retrospectively reviewed. The association between the amplitude reduction ratios of FCoMEPs and BR at the end of surgery and postoperative facial nerve function was determined. Subsequently, the optimal threshold of FCoMEPs and BR for predicting postoperative facial nerve dysfunction were determined by receiver operating characteristic curve analysis. RESULTS Valid BR was record in 103 of 110 patients, whereas only 43 patients successfully recorded FCoMEP in orbicularis oculi muscle. A reduction over 50.3% in FCoMEP (O. oris) amplitude was identified as a predictor of postoperative facial nerve dysfunction (sensitivity, 77.1%; specificity, 83.6%). BR was another independent predictor of postoperative facial nerve deficit with excellent predictive performance, especially eyelid closure function. Its optimal cut-off value for predicting long-term postoperative eyelid closure dysfunction was was 51.0% (sensitivity, 94.4%; specificity, 94.4%). CONCLUSIONS BR can compensate for the deficiencies of the FCoMEPs. The combination of BR and FCoMEPs can be used in CPA tumor surgery. SIGNIFICANCE The study first proposed an optimal cut-off value of BR amplitude deterioration (50.0%) for predicting postoperative eyelid closure deficits in patients undergoing CPA tumor surgery.
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Affiliation(s)
- Jiajia Liu
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Xing Fan
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Lirui Yang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Xiaorong Tao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Yanwen Jin
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Ke Li
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Jun Yang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.
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Khanna O, Hogan E, Alvarez R, Youssef AS. How I do it: hearing preservation in large vestibular schwannomas using vestibular nerve fiber preservation technique. Acta Neurochir (Wien) 2024; 166:105. [PMID: 38403779 DOI: 10.1007/s00701-024-05998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/03/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND To improve hearing function after resection of large vestibular schwannomas, we describe a strategy of vestibular-nerve-fiber preservation. Anatomical considerations and stepwise dissection are described. METHOD Steps include locating the vestibular nerve at the brainstem and identifying a dissection plane between nerve fibers and tumor capsule. Using this plane to mobilize and resect tumor reduced manipulation and maintained vascularity of underlying cochlear and facial nerves. CONCLUSION Preservation of hearing function is feasible in large vestibular schwannomas with vestibular-nerve-fiber preservation. Reducing manipulation and ischemic injury of underlying cochlear and facial nerves thereby helped facilitate hearing preservation, even in large tumors.
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Affiliation(s)
- Omaditya Khanna
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Elizabeth Hogan
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Reinier Alvarez
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
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Franz L, Marioni G, Daloiso A, Biancoli E, Tealdo G, Cazzador D, Nicolai P, de Filippis C, Zanoletti E. Facial Surface Electromyography: A Novel Approach to Facial Nerve Functional Evaluation after Vestibular Schwannoma Surgery. J Clin Med 2024; 13:590. [PMID: 38276096 PMCID: PMC10816927 DOI: 10.3390/jcm13020590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. METHODS Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. RESULTS In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5-3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman's model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman's rho: 0.8268, p < 0.0001). CONCLUSIONS We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG.
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Affiliation(s)
- Leonardo Franz
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Antonio Daloiso
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Elia Biancoli
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Giulia Tealdo
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Diego Cazzador
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Piero Nicolai
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Cosimo de Filippis
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Elisabetta Zanoletti
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
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Franz L, Marioni G, Mazzoni A, de Filippis C, Zanoletti E. Contemporary Perspectives in Pathophysiology of Facial Nerve Damage in Oto-Neurological and Skull Base Surgical Procedures: A Narrative Review. J Clin Med 2023; 12:6788. [PMID: 37959253 PMCID: PMC10650057 DOI: 10.3390/jcm12216788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
During the last decades, neuro-otological surgery has progressively reduced functional morbidity, including facial nerve damage. However, the occurrence of this sequela may significantly impact on patients' quality of life. The aim of this narrative review is to provide an update on the patho-physiological and clinical issues related to facial nerve damage in oto-neurological and skull base surgery, in the light of a comprehensive therapeutic and rehabilitative approach to iatrogenic disfunctions. The narrative review is based on a search in the PubMed, Scopus, and Web of Science databases. In this surgical setting, the onset of intraoperative facial nerve damage is related to various aspects, mainly concerning the anatomical relationship between tumor and nerve, the trajectory of the surgical corridor, and the boundaries of the resection margins. Mechanisms related to stretching, compression, devascularization, and heating may play a role in determining intraoperative facial nerve damage and provide the patho-physiological basis for possible nerve regeneration disorders. Most of the studies included in this review, dealing with the pathophysiology of surgical facial nerve injury, were preclinical. Future research should focus on the association between intraoperative trauma mechanisms and their clinical correlates in surgical practice. Further investigations should also be conducted to collect and record intraoperative data on nerve damage mechanisms, as well as the reports from neuro-monitoring systems.
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Affiliation(s)
- Leonardo Franz
- Phoniatric and Audiology Unit, Department of Neuroscience, University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
- Skull-Base Unit, Otolaryngology Section, Department of Neuroscience, University of Padova, 35122 Padova, Italy;
| | - Gino Marioni
- Phoniatric and Audiology Unit, Department of Neuroscience, University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Antonio Mazzoni
- Skull-Base Unit, Otolaryngology Section, Department of Neuroscience, University of Padova, 35122 Padova, Italy;
| | - Cosimo de Filippis
- Phoniatric and Audiology Unit, Department of Neuroscience, University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Elisabetta Zanoletti
- Skull-Base Unit, Otolaryngology Section, Department of Neuroscience, University of Padova, 35122 Padova, Italy;
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Di Perna G, De Marco R, Baldassarre BM, Lo Bue E, Cofano F, Zeppa P, Ceroni L, Penner F, Melcarne A, Garbossa D, Lanotte MM, Zenga F. Facial nerve outcome score: a new score to predict long-term facial nerve function after vestibular schwannoma surgery. Front Oncol 2023; 13:1153662. [PMID: 37377918 PMCID: PMC10291180 DOI: 10.3389/fonc.2023.1153662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Patients' quality of life (QoL), facial nerve (FN), and cochlear nerve (CN) (if conserved) functions should be pursued as final outcomes of vestibular schwannoma (VS) surgery. In regard to FN function, different morphologic and neurophysiological factors have been related to postoperative outcomes. The aim of the current retrospective study was to investigate the impact of these factors on the short- and long-term FN function after VS resection. The combination of preoperative and intraoperative factors resulted in designing and validating a multiparametric score to predict short- and long-term FN function. Methods A single-center retrospective analysis was performed for patients harboring non-syndromic VS who underwent surgical resection in the period 2015-2020. A minimum follow-up period of 12 months was considered among the inclusion criteria. Morphological tumor characteristics, intraoperative neurophysiological parameters, and postoperative clinical factors, namely, House-Brackmann (HB) scale, were retrieved in the study. A statistical analysis was conducted to investigate any relationships with FN outcome and to assess the reliability of the score. Results Seventy-two patients with solitary primary VS were treated in the period of the study. A total of 59.8% of patients showed an HB value < 3 in the immediate postoperative period (T1), reaching to 76.4% at the last follow-up evaluation. A multiparametric score, Facial Nerve Outcome Score (FNOS), was built. The totality of patients with FNOS grade A showed an HB value < 3 at 12 months, decreasing to 70% for those with FNOS grade B, whereas 100% of patients with FNOS grade C showed an HB value ≥ 3. The ordinal logistic regression showed three times increasing probability to see an HB value ≥ 3 at 3-month follow-up for each worsening point in FNOS score [Exp(B), 2,999; p < 0.001] that was even more probable [Exp(B), 5.486; p < 0.001] at 12 months. Conclusion The FNOS score resulted to be a reliable score, showing high associations with FN function both at short- and long-term follow-up. Although multicenter studies would be able to increase its reproducibility, it could be used to predict the FN damage after surgery and the potential of restoring its function on the long-term period.
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Affiliation(s)
- Giuseppe Di Perna
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
- Spine Surgery Unit, Casa di Cura "Città di Bra", Bra, Cuneo, Italy
| | - Raffaele De Marco
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Bianca Maria Baldassarre
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Enrico Lo Bue
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Pietro Zeppa
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Luca Ceroni
- Department of Psychology, University of Turin, Turin, Italy
| | - Federica Penner
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Antonio Melcarne
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Neurosurgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Neurosurgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
| | - Michele Maria Lanotte
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- Functional, Oncological and Stereotactic Neurosurgery Unit, “Città della Salute e delle Scienza” University Hospital, Turin, Italy
| | - Francesco Zenga
- Skull Base and Pituitary Surgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
- Neurosurgery Unit, “Città della Salute e della Scienza” University Hospital, Turin, Italy
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Dhayalan D, Perry A, Graffeo CS, Tveiten ØV, Muñoz Casabella A, Pollock BE, Driscoll CLW, Carlson ML, Link MJ, Lund-Johansen M. Salvage radiosurgery following subtotal resection of vestibular schwannomas: does timing influence tumor control? J Neurosurg 2023; 138:420-429. [PMID: 35907189 DOI: 10.3171/2022.5.jns22249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The goal of microsurgical resection of vestibular schwannoma (VS) is gross-total resection (GTR) to provide oncological cure. However, a popular strategy is to halt the resection if the surgical team feels the risk of cranial nerve injury is imminent, achieving a maximally safe subtotal resection (STR) instead. The tumor remnant can then be treated with stereotactic radiosurgery (SRS) once the patient has recovered from the immediate postoperative period, or it can be followed with serial imaging and treated with SRS in a delayed fashion if residual tumor growth is seen. In this study, the authors evaluated the efficacy of this multimodality approach, particularly the influence of timing and dose of SRS on radiological tumor control, need for salvage treatment, and cranial nerve function. METHODS VS patients treated with initial microsurgery and subsequent radiosurgery were retrospectively included from two tertiary treatment centers and dichotomized depending on whether SRS was given upfront (defined as before 12 months) or later. Radiological tumor control was defined as less than 20% tumor volume expansion and oncological tumor control as an absence of salvage treatment. Facial and cochlear nerve functions were assessed after surgery, at the time of SRS, and at last follow-up. Finally, a systematic literature review was conducted according to PRISMA guidelines. RESULTS A total of 110 VS patients underwent SRS following microsurgical resection, with a mean preradiosurgical tumor volume of 2.2 cm3 (SD 2.5 cm3) and mean post-SRS follow-up time of 5.8 years (SD 4.1 years). The overall radiological tumor control and oncological tumor control were 77.3% and 90.9%, respectively. Thirty-five patients (31.8%) received upfront SRS, while 75 patients (68.2%) were observed for a minimum of 12 months prior to SRS. The timing of SRS did not influence the radiological tumor control (p = 0.869), the oncological tumor control (p = 0.560), or facial nerve (p = 0.413) or cochlear nerve (p = 0.954) function. An escalated marginal dose (> 12 Gy) was associated with greater tumor shrinkage (p = 0.020) and superior radiological tumor control (p = 0.020), but it did not influence the risk of salvage treatment (p = 0.904) or facial (p = 0.351) or cochlear (p = 0.601) nerve deterioration. CONCLUSIONS Delayed SRS after close observation of residuals following STR is a safe alternative to upfront SRS regarding tumor control and cranial nerve preservation in selected patients.
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Affiliation(s)
- Dhanushan Dhayalan
- 1Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.,3Department of Clinical Medicine, University of Bergen, Norway; and
| | - Avital Perry
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Bruce E Pollock
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Colin L W Driscoll
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,4Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,4Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,4Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Morten Lund-Johansen
- 1Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.,3Department of Clinical Medicine, University of Bergen, Norway; and
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Yesehak B, Tirsit A. Facial nerve function and general outcome of patients operated for cerebellopontine angle tumors in Addis Ababa, Ethiopia, a retrospective study. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2022.101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Yakkala VK, Mammi M, Lamba N, Kandikatla R, Paliwal B, Elshibiny H, Corrales CE, Smith TR, Mekary RA. Audiovestibular symptoms and facial nerve function comparing microsurgery versus SRS for vestibular schwannomas: a systematic review and meta-analysis. Acta Neurochir (Wien) 2022; 164:3221-3233. [PMID: 35962847 DOI: 10.1007/s00701-022-05338-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic review and meta-analysis were conducted to compare the outcomes of surgery versus stereotactic radiosurgery (SRS). METHODS The Cochrane library, PubMed, Embase, and clinicaltrials.gov were searched through 01/2021 to find all studies on surgical and stereotactic procedures performed to treat vestibular schwannoma. Using a random-effects model, pooled odds ratios (OR) and their 95% confidence intervals (CI) comparing post- to pre-intervention were derived for pre-post studies, and pooled incidence of adverse events post-intervention were calculated for case series and stratified by intervention type. RESULTS Twenty-one studies (18 pre-post design; three case series) with 987 patients were included in the final analysis. Comparing post- to pre-intervention, both surgery (OR: 3.52, 95%CI 2.13, 5.81) and SRS (OR: 3.30, 95%CI 1.39, 7.80) resulted in greater odds of hearing loss, lower odds of dizziness (surgery OR: 0.10; 95%CI 0.02, 0.47 vs. SRS OR: 0.22; 95%CI 0.05, 0.99), and tinnitus (surgery OR: 0.23; 95%CI 0.00, 37.9; two studies vs. SRS OR: 0.11; 95%CI 0.01, 1.07; one study). Pooled incidence of facial symmetry loss was larger post-surgery (14.3%, 95%CI 6.8%, 22.7%) than post-SRS (7%, 95%CI 1%, 36%). Tumor control was larger in the surgery (94%, 95%CI 83%, 98%) than the SRS group (80%, 95%CI 31%, 97%) for small-to-medium size tumors. CONCLUSION Both surgery and SRS resulted in similar odds of hearing loss and similar improvements in dizziness and tinnitus among patients with vestibular schwannoma; however, facial symmetry loss appeared higher post-surgery.
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Affiliation(s)
- Vinod Kumar Yakkala
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Marco Mammi
- Department of Neurosurgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Nayan Lamba
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA
| | - Renuka Kandikatla
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Bhaskar Paliwal
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Hoda Elshibiny
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - C Eduardo Corrales
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA.
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Huang B, Ren Y, Liu X, Lan Z, Hui X, Ju Y, Li X, Zhang Y. Does preoperative gamma knife treatment affect the result of microresection of vestibular schwannoma? J Neurooncol 2022. [DOI: 10.1007/s11060-022-04140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
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Chiu SJ, Hickman SJ, Pepper IM, Tan JHY, Yianni J, Jefferis JM. Neuro-Ophthalmic Complications of Vestibular Schwannoma Resection: Current Perspectives. Eye Brain 2021; 13:241-253. [PMID: 34621136 PMCID: PMC8491867 DOI: 10.2147/eb.s272326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Vestibular schwannomas (VSs), also called acoustic neuromas, are benign intracranial neoplasms of the vestibulocochlear (VIII) cranial nerve. Management options include “wait-and-scan,” stereotactic radiosurgery and surgical resection. Due to the proximity of the VIII nerve to the facial (VII) nerve in the cerebello-pontine angle, the VII nerve is particularly vulnerable to the effects of surgical resection. This can result in poor eye closure, lagophthalmos and resultant corneal exposure post VS resection. Additionally, compression from the tumor or resection can cause trigeminal (V) nerve damage and a desensate cornea. The combination of an exposed and desensate cornea puts the eye at risk of serious ocular complications including persistent epithelial defects, corneal ulceration, corneal vascularization, corneal melting and potential perforation. The abducens (VI) nerve can be affected by a large intracranial VS causing raised intracranial pressure (a false localizing sign) or as a result of damage to the VI nerve at the time of resection. Other types of neurogenic strabismus are rare and typically transient. Contralaterally beating nystagmus as a consequence of vestibular dysfunction is common post-operatively. This generally settles to pre-operative levels as central compensation occurs. Ipsilaterally beating nystagmus post-operatively should prompt investigation for post-operative cerebrovascular complications. Papilledema (and subsequent optic atrophy) can occur as a result of a large VS causing raised intracranial pressure. Where papilledema follows surgical resection of a VS, it can indicate that cerebral venous sinus thrombosis has occurred. Poor visual function following VS resection can result as a combination of all these potential complications and is more likely with larger tumors.
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Affiliation(s)
- Stephanie J Chiu
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK
| | - Simon J Hickman
- Department of Medical Education, University of Sheffield, Sheffield, UK.,Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Irene M Pepper
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK
| | - Jennifer H Y Tan
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK
| | - John Yianni
- Department of Medical Education, University of Sheffield, Sheffield, UK.,Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Joanna M Jefferis
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Medical Education, University of Sheffield, Sheffield, UK.,Department of Neuro-Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK
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11
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Chiang KW, Hsu SPC, Yang TF, Wang MC. Impact of extent of internal acoustic meatus tumor removal using translabyrinthine approach for acoustic neuroma surgery. PLoS One 2021; 16:e0253338. [PMID: 34351928 PMCID: PMC8341598 DOI: 10.1371/journal.pone.0253338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/02/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives Many studies have investigated the surgical outcome and predictive factors of acoustic neuroma using different approaches. The present study focused on large tumors due to the greater likelihood of internal acoustic meatus involvement and the greater application of surgical intervention than radiosurgery. There have been no previous reports on outcomes of internal acoustic meatus tumor removal. We investigated the impact of the extent of internal acoustic meatus tumor removal using a translabyrinthine approach for large acoustic neuroma surgery and predictive factors of tumor control. Methods This retrospective study reviewed 104 patients with large cerebellopontine angle tumor >3 cm treated by translabyrinthine approach microsurgery. Predictive factors of postoperative facial palsy, tumor control, and extent of internal acoustic meatus tumor removal were assessed. Results The mean tumor size was 38.95 ± 6.83 mm. Postoperative facial function showed 76.9% acceptable function (House–Brackmann grade 1 or 2) six months after surgery. The extent of internal acoustic meatus tumor removal was a statistically significant predictor factor of poor postoperative facial function. Younger age, larger tumor size needing radiosurgery, and more extensive removal of tumor were associated with better tumor control. Conclusion More extensive internal acoustic meatus tumor removal was associated with poor postoperative facial function and better tumor control.
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Affiliation(s)
- Kuan-Wei Chiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sanford P. C. Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Departments of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsui-Fen Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mao-Che Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * E-mail:
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12
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Bulsara VM, Kim GS, Fouad AM, Bulsara MK, Santa Maria PL. Middle Cranial Fossa Approach to Repair Tegmen Dehiscence Using Self-setting Calcium Phosphate Cement: A Retrospective Case Review. Otol Neurotol 2021; 42:931-7. [PMID: 33710151 DOI: 10.1097/MAO.0000000000003110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To review the outcomes of repairing tegmen dehiscence using the middle cranial fossa approach with a self-setting bone cement. STUDY DESIGN Retrospective case series. SETTING Two academic tertiary hospitals. PATIENTS All patients presenting for surgical repair of tegmen dehiscence and with postoperative follow-up for at least 6 months between October 2015 and July 2019. INTERVENTION Surgical repair using a middle cranial fossa approach using a layered reconstruction with temporalis fascia and self-setting calcium phosphate bone cement. MAIN OUTCOME MEASURES Perioperative complications, recurrence of presenting symptoms/disease, hearing, and facial nerve grade. RESULTS The cohort consisted of 22 patients with 23 tegmen dehiscence repairs (1 sequential bilateral repair). There were 16 males and 6 females with an average age at operation of 52.6 years. Repairs were left sided in 9, right sided in 12 patients, and bilateral in 1 patient. No patients had recurrence of presenting symptoms or disease at most recent follow-up. Preoperative hearing was maintained in all patients. Two patients (9% of repairs) experienced delayed partial temporary facial nerve weakness House-Brackman grade 2 and 4 which had recovered by 8 weeks postoperative. CONCLUSION We demonstrate a technique for repairing tegmen dehiscence of the middle cranial fossa floor that has excellent postoperative outcomes. We highlight potential technical challenges in this approach as well as the need for counseling for potential partial transient facial nerve dysfunction.
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13
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Hostettler IC, Jayashankar N, Bikis C, Wanderer S, Nevzati E, Karuppiah R, Waran V, Kalbermatten D, Mariani L, Marbacher S, Guzman R, Madduri S, Roethlisberger M. Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery-A Systematic Review and Future Perspectives. Front Bioeng Biotechnol 2021; 9:659413. [PMID: 34239858 PMCID: PMC8259738 DOI: 10.3389/fbioe.2021.659413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background and purpose: Tumorous lesions developing in the cerebellopontine angle (CPA) get into close contact with the 1st (cisternal) and 2nd (meatal) intra-arachnoidal portion of the facial nerve (FN). When surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery. This article aims to provide a systematic overview for translational research by establishing the current evidence on available clinical studies and experimental models reporting on intracranial FN injury. Methods: A systematic literature search of several databases (PubMed, EMBASE, Medline) was performed prior to July 2020. Suitable articles were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Included clinical studies were reviewed and categorized according to the pathology and surgical resection strategy, and experimental studies according to the animal. For anatomical study purposes, perfusion-fixed adult New Zealand white rabbits were used for radiological high-resolution imaging and anatomical dissection of the CPA and periotic skull base. Results: One hundred forty four out of 166 included publications were clinical studies reporting on FN outcomes after CPA-tumor surgery in 19,136 patients. During CPA-tumor surgery, the specific vulnerability of the intracranial FN to stretching and compression more likely leads to neurapraxia or axonotmesis than neurotmesis. Severe FN palsy was reported in 7 to 15 % after vestibular schwannoma surgery, and 6% following the resection of CPA-meningioma. Twenty-two papers reported on experimental studies, out of which only 6 specifically used intracranial FN injury in a rodent (n = 4) or non-rodent model (n = 2). Rats and rabbits offer a feasible model for manipulation of the FN in the CPA, the latter was further confirmed in our study covering the radiological and anatomical analysis of perfusion fixed periotic bones. Conclusion: The particular anatomical and physiological features of the intracranial FN warrant a distinguishment of experimental models for intracranial FN injuries. New Zealand White rabbits might be a very cost-effective and valuable option to test new experimental approaches for intracranial FN regeneration. Flexible and bioactive biomaterials, commonly used in skull base surgery, endowed with trophic and topographical functions, should address the specific needs of intracranial FN injuries.
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Affiliation(s)
- Isabel C Hostettler
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Narayan Jayashankar
- Department of Oto-Rhino-Laryngology, Nanavati Super Speciality Hospital, Mumbai, India
| | - Christos Bikis
- Department of Biomedical Engineering, Biomaterials Science Center, University of Basel, Allschwil, Switzerland.,Integrierte Psychiatrie Winterthur - Zürcher Unterland, Winterthur, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Kantonsspital Luzern, Lucerne, Switzerland
| | - Ravindran Karuppiah
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniel Kalbermatten
- Department of Plastic Surgery, University Hospital Geneva, Geneva, Switzerland.,Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Srinivas Madduri
- Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia.,Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
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14
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Funk EK, Greene JJ. Advances in Facial Reanimation: Management of the Facial Nerve in the Setting of Vestibular Schwannoma. Curr Otorhinolaryngol Rep 2021. [DOI: 10.1007/s40136-021-00343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Matsumine H, Niimi Y, Matsumine H. An electrophysiological evaluation method for the ovine facial nerve. Regen Ther 2021; 18:76-81. [PMID: 33969162 DOI: 10.1016/j.reth.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/12/2021] [Accepted: 03/26/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Large-animal models such as sheep for facial nerve regeneration research have not yet been established because of the lack of methods for assessing the electrophysiological function of regenerated nerves. In this study, we developed a percutaneous measurement method for the evoked compound muscle action potential (CMAP) of the facial nerve in sheep. Methods Six 3-year-old castrated male Corriedale sheep were used in this study. Under general anesthesia, an anatomical exploration was performed to identify the course of the buccal branch of the facial nerve and its innervating muscles on one side, followed by the application of surface stimulating electrodes to the contralateral side of the face along the course of the buccal branch of the facial nerve to obtain CMAP measurements of the nasolabial levator muscle. Results Percutaneous CMAP measurements of the nasolabial levator muscle could be obtained in all animals by placing stimulating electrodes 1 cm apart on the line coinciding with the course of the buccal branch of the facial nerve revealed by the preceding anatomical exploration. Mean values for electrophysiological parameters were amplitude 4.7 ± 0.7 mV, duration 2.1 ± 0.6 ms, and latency 3.6 ± 0.4 ms. Conclusion We have established a percutaneous measurement method for CMAP of the buccal branch of the facial nerve in sheep. This method is expected to be very useful in future studies of facial nerve regeneration for long nerve defects in sheep. A percutaneous CMAP measurement method for the ovine facial nerve was established. Anatomical experiment demonstrated the method's physiological accuracy. The ovine facial nerve enables a more realistic model of facial nerve regeneration.
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Ren Y, MacDonald BV, Tawfik KO, Schwartz MS, Friedman RA. Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma. Otolaryngol Head Neck Surg 2020; 164:1085-1093. [PMID: 33048002 DOI: 10.1177/0194599820961389] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify clinical predictors of facial nerve (FN) outcomes after microsurgical resection of vestibular schwannoma (VS). STUDY DESIGN Prospective cohort study. SETTING Academic medical center. METHODS Consecutive patients undergoing VS resection from November 2017 to October 2019 were included. FN function was evaluated with the House-Brackmann (HB) scale and stratified into good (HB I-II) and poor (HB III-VI) function. Analyses included descriptive statistics, correlation, and logistic regression. RESULTS Of 256 patients who met criteria (mean age, 47.7 years; 62.5% female), 227 (88.7%) achieved good FN function postoperatively and 238 (93.0%) at latest follow-up (mean, 154.8 days). Operative approaches consisted of translabyrinthine (50.8%), retrosigmoid (25.0%), and middle fossa craniotomies (24.2%). Extent of resection was decided intraoperatively, and gross or near total resection was accomplished in 237 (92.6%) cases. Postoperative HB grade correlated with latest HB grade (0.615, P < .001). Factors associated with good postoperative FN function included small tumor size (≤15 mm; odds ratio [OR], 2.425; P = .042), gross or near total resection (OR, 3.170; P = .041), and ≥100-µV intraoperative FN electromyographic response to a 0.05-mA stimulus (OR, 22.242; P < .001). Factors associated with good FN function at latest follow-up included gross total resection (OR, 7.764; P = .003) and ≥100-µV FN electromyographic response (OR, 8.518; P < .001), accounting for surgical approach and tumor size. CONCLUSION Microsurgical resection of VS can be accomplished with excellent FN outcomes. Gross total resection and ≥100-µV intraoperative FN electromyographic response predicted excellent FN outcomes. Immediate postoperative FN function is a prognosticator of long-term FN function.
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Affiliation(s)
- Yin Ren
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California at San Diego, La Jolla, California, USA
| | - Bridget V MacDonald
- School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Kareem O Tawfik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California at San Diego, La Jolla, California, USA.,Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc S Schwartz
- Department of Neurosurgery, University of California at San Diego, La Jolla, California, USA
| | - Rick A Friedman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California at San Diego, La Jolla, California, USA
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17
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Hosoya M, Oishi N, Nishiyama T, Noguchi M, Kasuya K, Suzuki N, Miyazaki H, Ogawa K. Preoperative electrophysiological analysis predicts preservation of hearing and facial nerve function following vestibular schwannoma surgery with continuous intraoperative neural monitoring: Clinical outcomes of 22 cases. Clin Otolaryngol 2019; 44:875-880. [PMID: 31264375 DOI: 10.1111/coa.13399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/15/2019] [Accepted: 06/27/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Makoto Hosoya
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Oishi
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Nishiyama
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Noguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kento Kasuya
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noriomi Suzuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hidemi Miyazaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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MARCOS-ALONSO S, VILLAOSLADA-FUENTES R, MUÑOZ-HERRERA Á, BATUECAS-CALETRÍO Á, SANTA-CRUZ-RUÍZ S, MARTÍNEZ-CARRANZA RA. Cirugía del schwannoma vestibular. Factores predisponentes y predictores de parálisis facial. Rev ORL 2019. [DOI: 10.14201/orl.20152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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19
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Goshtasbi K, Abouzari M, Moshtaghi O, Maducdoc M, Lehrich BM, Lin HW, Djalilian HR. Risk Recall of Complications Associated with Vestibular Schwannoma Treatment. Otolaryngol Head Neck Surg 2019; 161:330-335. [PMID: 30885097 DOI: 10.1177/0194599819837257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the risk recall of complications among patients who underwent different vestibular schwannoma (VS) treatments. STUDY DESIGN Patients with VS completed a voluntary and anonymous survey. SETTING Survey links were distributed via the Acoustic Neuroma Association (ANA) website, Facebook, and email list. SUBJECTS AND METHODS Surveys were distributed to ANA members from January to March 2017. Of the 3200 ANA members with a VS diagnosis at the time of survey distribution, 789 (25%) completed the survey. RESULTS Subjects reported the following incidence of posttreatment complications: imbalance (60%), hearing issues (51%), dry eyes (30%), headache (29%), and facial weakness (27%). Overall, 188 (25%) recalled remembering all the risks associated with their treatment. Among those in the surgical cohort (52%) who experienced balance issues, facial weakness, cerebrospinal fluid leak, meningitis, and stroke, 73%, 91%, 77%, 67%, and 33% claimed recall of these associated risks. Among those in the radiosurgery cohort (28%) who experienced balance issues, facial weakness, and hydrocephalus, 56%, 52%, and 60% recalled discussions of those risks. Patients with higher-level education (P = .026) and those who underwent surgery (P = .001) had a significantly higher risk recall ratio, while sex, age, and tumor size were not significant contributing factors. CONCLUSION Not all patients with VS who experienced treatment complications recalled remembering those risks being discussed with them. Patients with higher education and those who underwent surgery had a better recall of risks associated with different treatment modalities. The risk recall ratio of patients experiencing complications ranged 33% to 91%, suggesting an opportunity for decision-making and discussion improvement.
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Affiliation(s)
- Khodayar Goshtasbi
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Mehdi Abouzari
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Omid Moshtaghi
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Marlon Maducdoc
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Brandon M Lehrich
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA.,2 Department of Biomedical Engineering, University of California-Irvine, Irvine, California, USA
| | - Harrison W Lin
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Hamid R Djalilian
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA.,2 Department of Biomedical Engineering, University of California-Irvine, Irvine, California, USA
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20
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Niimi Y, Matsumine H, Fukuda S, Salsbury JR, Niimi Y, Herndon DN, Prough DS, Enkhbaatar P. Surgical anatomy of ovine facial and hypoglossal nerves for facial nerve reconstruction and regeneration research: An experimental study in sheep. Microsurgery 2019; 40:51-58. [PMID: 30666707 DOI: 10.1002/micr.30405] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 10/16/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The lack of a clinically relevant animal model for facial nerve research is a challenge. The goal of this study was to investigate the anatomy of the ovine facial and hypoglossal nerves to establish a clinically relevant facial nerve research model. MATERIALS AND METHODS Six cadaver female Merino sheep (33.5 ± 3 kg, approximately 3 years old) and three anesthetized female Merino sheep (30 ± 3 kg, approximately 3 years old) were used. In cadaver sheep, a right side preauricular to submandibular incision was made. Dimensions of the face, neck, and length of facial nerve were measured. In anesthetized sheep, each facial nerve branch and hypoglossal nerve in the right side was stimulated. The number of myelinated fibers was analyzed histologically. RESULTS The facial nerve exited the stylomastoid foramen and divided into upper and lower branches. The lower branch then subdivided into buccal and marginal mandibular branches. The hypoglossal nerve was observed behind the digastric posterior belly. Stimulation revealed the temporal, zygomatic, buccal, marginal mandibular, and cervical branch innervated the forehead, orbicularis, upper lip and nasal, lower lip, and platysma, respectively. The number of myelinated fibers of the main trunk, upper, buccal, lower branch, and hypoglossal nerve was 11 350 ± 1851, 4766 ± 1000, 5107 ± 218, 3159 ± 450, and 7604 ± 636, respectively. The length of the main trunk was 9.2 ± 1.5 mm, and distance of the marginal mandibular branch to the facial artery was 94 ± 6.8 mm. CONCLUSIONS Due to the similarity in nerve anatomy and innervation, the ovine model can be used as a clinically relevant and suitable model for facial nerve research.
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Affiliation(s)
- Yosuke Niimi
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas.,Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hajime Matsumine
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Fukuda
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - John R Salsbury
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Yu Niimi
- Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, Chiyoda-ku, Tokyo, Japan
| | - David N Herndon
- Department of Surgery, Shriners Hospital for Children, Galveston, Texas
| | - Donald S Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas.,Department of Surgery, Shriners Hospital for Children, Galveston, Texas
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Singhal S, Singhal G, Agrawal G, Shrivastav A, Jagetia A, Singhal D, Gangil J. Electrophysiological Monitoring of Fifth and Seventh Cranial Nerves in Cerebellopontine Angle Lesions. MAMC J Med Sci 2019. [DOI: 10.4103/mamcjms.mamcjms_58_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Gidley PW, Maw J, Gantz B, Kaylie D, Lambert P, Malekzadeh S, Chandrasekhar SS. Contemporary Opinions on Intraoperative Facial Nerve Monitoring. OTO Open 2018; 2:2473974X18791803. [PMID: 31535063 PMCID: PMC6737880 DOI: 10.1177/2473974x18791803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/27/2018] [Accepted: 07/10/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To examine the current trend in intraoperative facial nerve monitoring (IOFNM) training, performance, and reimbursement by subspecialists. Study Design Cross-sectional survey of the American Neurotology Society, American Otological Society, American Society of Pediatric Otolaryngology, and program directors of otolaryngology-head and neck surgery programs accredited by the Accreditation Council on Graduate Medical Education. Setting American Academy of Otolaryngology-Head and Neck Surgery Intraoperative Nerve Monitoring Task Force. Subjects and Methods The task force developed 2 surveys, which were implemented through Surveymonkey.com: (1) a 10-question survey sent to 1506 members of the societies listed to determine IOFNM practice and reimbursement patterns and (2) a 10-question survey sent to the 107 accredited US otolaryngology residency program directors to examine the state of resident training on facial nerve monitoring. Results Response rates were 18% for practicing physicians and 15% for residency program directors. The majority agreed that IOFNM was indicated for most otologic and neurotologic procedures. In addition to facial nerve monitoring, facial nerve stimulation was used in complex skull base and temporal bone procedures. When queried about reimbursement by Medicare, only 4.4% of surgeons responded that they received reimbursement. Program directors indicated universal exposure of residents to IOFNM, with 61% of programs giving residents formal training. Conclusions IOFNM is widely used among otologists and neurotologists in the United States. The majority of residents receive formal training, and all residents are exposed to the setup, use, monitoring, and troubleshooting of the device. Reimbursement for IOFNM is reported by a paucity of those surveyed.
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Affiliation(s)
- Paul W. Gidley
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Paul W. Gidley, MD, Department of Head and Neck Surgery, UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
| | - Jennifer Maw
- Ear Associates & Rehabilitation Services, San Jose, California, USA
| | - Bruce Gantz
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David Kaylie
- Duke University Medical Center, Durham, North Carolina, USA
| | - Paul Lambert
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology, Georgetown University Medical Center, Washington, DC, USA
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Puanhvuan D, Chumnanvej S, Wongsawat Y. Peripheral nerve function estimation by linear model of multi-CMAP responses for surgical intervention in acoustic neuroma surgery. Physiol Rep 2017; 5. [PMID: 29192065 PMCID: PMC5727268 DOI: 10.14814/phy2.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/24/2022] Open
Abstract
Nerve function assessments are crucial for surgical intervention during acoustic neuroma surgery. Cranial nerves such as acoustic and facial nerves, can be possibly damaged during tumor dissection. Proper surgical intervention should prevent neurological deficit and achieve total tumor removal. Conventionally, nerve function is qualitatively evaluated by surgeon and neurologist. Facial nerves can be preserved by monitoring the compound muscle action potential (CMAP) response. The differences in the amplitude and latency of CMAP are used as indicators during surgical interventions. However, baseline CMAPs cannot be recorded in the presence of large acoustic tumors. This paper presents a new way of estimating nerve function. Instead of a single CMAP examination, multi‐CMAP responses are obtained from a train of varied stimulus intensities and these are applied a mathematical model. Shifts in the mathematical model parameters reflect changes in facial nerve function. In this study, experiments conducted in frog revealed that shifts in the linear model parameters were related to the level of induced nerve injury. Significant differences in the slope parameter of the linear model were found between each nerve condition. The identification of healthy and severed nerves via a support vector machine (SVM) corresponded to 94% accuracy. This classification criterion could be used with surgical intervention to prevent severed facial nerve palsy in acoustic neuroma surgery. The proposed method could be used to estimate nerve outcomes without prior information of a CMAP baseline.
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Affiliation(s)
- Dilok Puanhvuan
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Sorayouth Chumnanvej
- Surgery Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yodchanan Wongsawat
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Salaya, Nakhon Pathom, Thailand
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Fotakopoulos G, Fountas K, Tsianaka E, Kotlia P, Pachatouridis D, Paschalis T, Voulgaris S. Could IGF-I levels play a neuroprotective role in patients with large vestibular schwannomas? Future Sci OA 2018; 4:FSO260. [PMID: 29379636 DOI: 10.4155/fsoa-2017-0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022] Open
Abstract
Aim To evaluate the possible superiority of outcome in patients with elevated IGF-I levels after vestibular schwannoma (VS) resection. Patients & methods This retrospective study included 65 patients (34 male, 52.3%) with VS operated in between January 2009 and April 2014 (follow-up 3.2 ± 0.7 years). Preoperative or postoperative IGF-I levels were identified for each patient. Results Patients were divided into two groups: Group A (small size tumor), 56 patients; and Group B (large size tumor), 9 cases. IGF-I levels in Group A (195.8 ± 32.9 ng/ml) were compared with those of Group B (242.2 ± 22.2 ng/ml) and were found to have statistically significant difference (p = 0.001). Conclusion Increased IGF-I levels could hold a key role in nerve recovery in patients undergoing surgical resection of large VS.
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Mooney MA, Hendricks B, Sarris CE, Spetzler RF, Almefty KK, Porter RW. Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy. J Neurol Surg B Skull Base 2017; 79:309-313. [PMID: 29765830 DOI: 10.1055/s-0037-1607320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design A retrospective review. Setting Single-institution cohort. Participants Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures Incidence, House-Brackmann grade. Results Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1-4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House-Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Benjamin Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Christina E Sarris
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Randall W Porter
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
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Tveiten ØV, Carlson ML, Goplen F, Myrseth E, Driscoll CLW, Mahesparan R, Link MJ, Lund-Johansen M. Patient- versus physician-reported facial disability in vestibular schwannoma: an international cross-sectional study. J Neurosurg 2017; 127:1015-1024. [DOI: 10.3171/2016.8.jns16707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVEPatient-reported outcomes are increasingly used in studies of vestibular schwannoma (VS); however, few studies have examined self-evaluated facial nerve function and its relation to physician-reported outcomes. The primary objective of this study was to compare patient self-evaluations of facial disability with physician-evaluated facial nerve status and with self-evaluations of a healthy control group. The second objective was to provide insight into the controversial subject of the optimal initial management of small- and medium-sized VSs; consequently, the authors compared patient-reported facial nerve disability following treatment via observation (OBS), Gamma Knife surgery (GKS), or microsurgery (MS). Lastly, the authors sought to identify risk factors for facial nerve dysfunction following treatment for small- and medium-sized VSs.METHODSAll patients with a VS 3 cm or smaller that was singly treated with OBS, GKS, or MS at either of 2 independent treatment centers between 1998 and 2008 were retrospectively identified. Longitudinal facial nerve measures and clinical data, including facial nerve evaluation according to the House-Brackmann (HB) grading system, were extracted from existing VS databases. Supplementing the objective data were Facial Disability Index (FDI) scores, which were obtained via survey of patients a mean of 7.7 years after initial treatment.RESULTSThe response rate among the 682 eligible patients was 79%; thus, data from a total of 539 patients were analyzed. One hundred forty-eight patients had been managed by OBS, 247 with GKS, and 144 with MS. Patients who underwent microsurgery had larger tumors and were younger than those who underwent OBS or GKS. Overall, facial nerve outcomes were satisfactory following treatment, with more than 90% of patients having HB Grade I function at the last clinical follow-up. Treatment was the major risk factor for facial nerve dysfunction. Almost one-fifth of the patients treated with MS had an objective decline in facial nerve function, whereas only 2% in the GKS group and 0% in the OBS cohort had a decline. The physical subscale of the FDI in the VS patients was highly associated with HB grade; however, the social/well-being subscale of the FDI was not. Thus, any social disability caused by facial palsy was not detectable by use of this questionnaire.CONCLUSIONSThe majority of patients with small- and medium-sized VSs attain excellent long-term facial nerve function and low facial nerve disability regardless of treatment modality. Tumor size and microsurgical treatment are risk factors for facial nerve dysfunction and self-reported disability. The FDI questionnaire is sensitive to the physical but not the social impairment associated with facial dysfunction.
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Affiliation(s)
- Øystein Vesterli Tveiten
- Departments of 1Neurosurgery and
- 3Department of Clinical Medicine, University of Bergen, Norway; and
| | - Matthew L. Carlson
- 5Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
- Departments of 4Neurologic Surgery and
| | | | | | - Colin L. W. Driscoll
- Departments of 4Neurologic Surgery and
- 5Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | | | - Michael J. Link
- Departments of 4Neurologic Surgery and
- 5Otolaryngology–Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Morten Lund-Johansen
- Departments of 1Neurosurgery and
- 3Department of Clinical Medicine, University of Bergen, Norway; and
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Wong RH, Copeland WR, Jacob JT, Sivakanthan S, Van Gompel JJ, van Loveren H, Link MJ, Agazzi S. Anterior Extension of Tumor is as Important as Tumor Size to Facial Nerve Outcome and Extent of Resection for Vestibular Schwannomas. J Neurol Surg B Skull Base 2017; 78:473-480. [PMID: 29134166 DOI: 10.1055/s-0037-1604331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/08/2017] [Indexed: 10/19/2022] Open
Abstract
Objectives We examined vestibular schwannoma tumor dimension and direction of growth to determine whether these correlate with facial nerve outcome as well as extent of resection (EOR). Design Retrospective review of prospectively maintained databases. Participants 206 patients were a part of this study. Main Outcome Measures Tumor dimensions were measured using preoperative magnetic resonance imaging, and a series of ratios were then calculated to further characterize tumor dimension. Regression analyses were performed to investigate correlation with facial nerve outcome and EOR. Results Patients with tumor extending >1.5 cm anterior to the internal auditory canal (IAC) (AB measurement) were three times more likely to have postoperative House-Brackman grades of 3 or worse. We also found that an EB/BF ratio (representing elongated growth parallel to the IAC axis) ≥1.1 was associated with half the risk of poor facial nerve outcome. Tumors with anterior-posterior diameter (AC measurement) >1.9 cm were five times less likely to undergo gross total resection (GTR). Furthermore, an increased degree of tumor extension into the IAC (DE measurement >2.4 cm) or an increased amount of brainstem compression (EB measurement >1.1 cm) were each associated with a nearly 3-fold decrease in the likelihood of GTR. Conclusion Our study demonstrates that anterior extent of the tumor is as important as tumor size to facial nerve outcome and degree of resection for vestibular schwannomas.
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Affiliation(s)
- Ricky H Wong
- Department of Neurologic Surgery, NorthShore University Health System, Pritzker School of Medicine, Evanston, Illinois, United States
| | - William R Copeland
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeffrey T Jacob
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Sananthan Sivakanthan
- Department of Neurologic Surgery, University of New Mexico, Albuquerque, New Mexico, United States
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Harry van Loveren
- Department of Neurologic Surgery, University of South Florida, Tampa, Florida, United States
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Siviero Agazzi
- Department of Neurologic Surgery, University of South Florida, Tampa, Florida, United States
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Grahnke K, Garst JR, Martin B, Leonetti JP, Anderson DE. Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas. J Neurol Surg B Skull Base 2017; 78:454-460. [PMID: 29134163 DOI: 10.1055/s-0037-1604077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022] Open
Abstract
This study analyzes the simple ratio of anterior-to-posterior extension of large (>2.5 cm) acoustic neuromas relative to the internal auditory canal (ICA; anterior-posterior [A/P] index) as a tool for predicting risk of facial nerve (FN) injury. In total, 105 patients who underwent microsurgical resection for large acoustic neuromas were analyzed retrospectively. House-Brackmann (HB) scores were assessed immediately postoperatively, at 1 month, and at 1 year. Lateral-medial, inferior-superior, A/P, and maximum diameters were measured from preoperative magnetic resonance images. These measurements and the A/P index were analyzed using univariable and multivariable statistical models to assess relationship to FN outcomes. The retrosigmoid, translabyrinthine, and combined approaches were used, and the extent of resection was evaluated. For every 1 standard deviation increase in the A/P index, a patient was 3.87 times more likely have a higher postoperative HB score ( p < 0.0001). Accordingly, for every 1-mm increase anterior to the IAC, a patient was 16% more likely have a higher postoperative HB score ( p < 0.001). After controlling for tumor size, a patient was still 3.82 times more likely have a higher postoperative HB score for every 1 standard deviation increase in the A/P index ( p < 0.0001). While larger tumor size trended toward worse postoperative HB scores, it was not statistically significant. Our prognostic index may be useful to assess the risk of FN injury preoperatively for large acoustic neuromas, while also providing information about the tumor-nerve relationship.
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Affiliation(s)
- Kurt Grahnke
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - Jonathan R Garst
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - Brendan Martin
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - John P Leonetti
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
| | - Douglas E Anderson
- Department of Neurological Surgery and Otolaryngology, Head and Neck Surgery, Loyola University Chicago, Maywood, Illinois, United States
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Abstract
OBJECTIVE To identify factors associated with treatment modality selection in acoustic neuromas. STUDY DESIGN Prospective observational study. SETTING Tertiary care neurotology clinic. PATIENTS Data were prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have magnetic resonance imaging (MRI), demographic, psychometric, or audiometric data were excluded from analysis. INTERVENTION Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis. MAIN OUTCOME MEASURE The decision to pursue acoustic neuroma surgical resection versus active surveillance. RESULTS A total of 216 patients with acoustic neuroma (mean age 55 years, 58% women) were included. Ninety eight patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age less than 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache, and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p < 0.05). There was no significant association between surgical intervention and preoperative quality of life, depression, and self-esteem scores. On multiple logistic regression analysis, the likelihood of undergoing surgical resection significantly decreased for patients older than age 65 (odds ratio [OR] 0.19; 0.05-0.69) and increased in patients with medium (OR 4.34; 1.36-13.81), moderately large (OR 33.47; 5.72-195.83), large grade tumors (OR 56.63; 4.02-518.93), tumor growth present (OR 4.51; 1.66-12.28), Class D hearing (OR 3.96; 1.29-12.16), and higher headache severity scores (OR 1.03; 95% confidence interval [CI] 1.01-1.05). The likelihood of undergoing surgical resection was completely predictive for giant grade tumors and not significant for small grade tumors and Class B or C hearing. CONCLUSIONS Non-elderly acoustic neuroma patients with larger tumors, growing tumors, significant hearing loss, and worse headaches are more likely to pursue surgical resection rather than active surveillance. Psychological factors such as quality of life, depression, and self-esteem do not seem to influence decision-making in this patient population.
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Affiliation(s)
- Jason C Nellis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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Abstract
CONCLUSION In this series, the split type hypoglossal-facial nerve anastomosis resulted in more favorable outcomes in terms of both facial function and tongue atrophy. OBJECTIVE This study compared surgical techniques for hypoglossal-facial nerve anastomosis after schwannoma removal and evaluated which technique achieves better facial outcomes and less tongue morbidity. METHOD This study included 14 patients who underwent hypoglossal-facial nerve anastomosis after schwannoma removal and were followed for more than 1 year. Three surgical techniques were performed: end-to-end, end-to-side, and split anastomoses. Facial palsy and tongue atrophy after anastomosis were evaluated using the scales suggested by House-Brackmann and Martins, respectively. Tumor volume and the time to surgery were also evaluated, and the effects on facial outcomes were analyzed. RESULTS Overall, nine of 14 (64.3%) patients had favorable facial outcomes, and eight of 14 (57.1%) had favorable tongue outcomes. Regarding facial palsy, five of seven (71.4%) end-to-end, three of four (75%) split, and only one of three (33.3%) end-to-side patients had favorable facial function. Regarding tongue atrophy, all three (100%) end-to-side, three of four (75%) split, and two of seven (28.6%) end-to-end patients had favorable tongue outcomes. The effects of tumor volume and time to surgery on facial outcome were not significant.
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Bhatt NK, Mejias C, Kallogjeri D, Gale DC, Park AM, Paniello RC. Potassium titanyl phosphate laser welding following complete nerve transection. Laryngoscope 2016; 127:1525-1530. [DOI: 10.1002/lary.26383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/04/2016] [Accepted: 09/27/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Neel K. Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Christopher Mejias
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Derrick C. Gale
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Andrea M. Park
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
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Rahimpour S, Friedman AH, Fukushima T, Zomorodi AR. Microsurgical resection of vestibular schwannomas: complication avoidance. J Neurooncol 2016; 130:367-75. [DOI: 10.1007/s11060-016-2260-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
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Roessler K, Krawagna M, Bischoff B, Rampp S, Ganslandt O, Iro H, Schmitt H, Buchfelder M. Improved Postoperative Facial Nerve and Hearing Function in Retrosigmoid Vestibular Schwannoma Surgery Significantly Associated with Semisitting Position. World Neurosurg 2016; 87:290-7. [PMID: 26732954 DOI: 10.1016/j.wneu.2015.11.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The pros and cons of semisitting positioning (SSP) versus lateral, horizontal positioning (LP) during retrosigmoid vestibular schwannoma (VS) surgery, especially concerning postoperative cranial nerve and brain stem preservation, are under continuous discussion. METHODS In a single-center retrospective cohort study, 30 VSs operated on in SSP compared with 30 operated on in LP with comparable demography were analyzed. During SSP surgery, transesophageal echocardiographic monitoring for venous air embolism was used continuously. Electrophysiologic cranial nerve monitoring was used in both groups. RESULTS Length of surgery was significantly different between both groups: 183 minutes mean in SSP surgery versus 365 minutes mean in LP surgery (P = 0.0001). Postoperative rates of facial palsy and hearing loss were also significantly different. Six months postoperatively, 63% had normal facial nerve function after SSP surgery, whereas in LP surgery, 40% had no facial palsy (P = 0.02). Hearing preservation rate was also significantly different: 44% in SSP surgery compared with 14% in LP surgery who had preserved hearing (P = 0.006). Because of cerebrospinal fluid leaks, there were 3 operative revisions in the LP group (10%) and 1 (3.3%) in the SSP group. A clinically insignificant venous air embolism rate was found in 3.3% of patients (1/30) during SSP surgery. The neurologic outcome after 6 months was 1.2 on the Rankin Scale in the LP group and 1.0 in the SSP group, with zero mortality. CONCLUSIONS SSP compared with LP surgery was associated with significantly shorter operation time and better facial and cochlear nerve function in VS surgery postoperatively, without differences in complication rates.
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Kunert P, Dziedzic T, Podgórska A, Nowak A, Czernicki T, Marchel A. Surgery for sporadic vestibular schwannoma. Part IV. Predictive factors influencing facial nerve function after surgery. Neurol Neurochir Pol 2015; 50:36-44. [PMID: 26851688 DOI: 10.1016/j.pjnns.2015.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyze the impact of various clinical, radiological and perioperative factors that could influence the facial nerve intraoperative disruption risk (CNVII-IDR) and its long-term function (CNVII-LTF) after vestibular schwannoma (VS) surgery. MATERIAL AND METHODS The study included 212 patients operated on for sporadic VS with no history of previous treatment for VS or CNVII palsy. The mean size of the tumor was 30 mm. Gross (210) or near-total (2) resections were carried out using the retrosigmoid (210) or translabyrinthine (2) approach. Correlation studies and multivariate regression analysis (RA) were performed. RESULTS In correlation studies, the CNVII-IDR was increased by: headaches and cerebellar ataxia if one of them was the first symptom of the tumor (33% and 29%, respectively, p=0.008); preoperative hydrocephalus (40% vs. 9%, p=0.01), tumor size >3 cm (18% vs. 5%, p<0.01), tumor volume >10 cm(3) (19% vs. 4%, p<0.01), right-sided location 15% vs. 6%, p=0.047), lateral "park-bench" position (19% vs. 5% for supine position, p<0.01) and the procedure order (16% for the first 106 procedures vs. 6% for the last 106 procedures, p<0.05). In RA the tumor volume (p=0.012), side of the tumor (p=0.028) and patient's position during surgery (p=0.016) independently affected the CNVII-IDR. The following factors correlated significantly with satisfactory CNVII-LTF (HB grades I-III): tumor stage <T4 (p=0.000), tumor size ≤3 cm (p=0.000), tumor volume ≤10 cm(3) (p=0.001), and left-sided location (p=0.048). Additional factors correlated significantly with very good CNVII-LTF (HB grades I-II): anterior CNVII displacement (p=0.044), nimodipine use (p=0.016), the absence of postoperative complications (p=0.019), CNVII responsive on final intraoperative EMG stimulation (p=0.000) and supine position during surgery (p=0.018). However, an independent impact on very good CNVII-LTF proved to be the tumor size (p=0.0000), side (p=0.0175), and nimodipine use (p=0.0349). CONCLUSIONS In our series, the factors related to size and side of the tumor confirmed an independent impact on CNVII-IDR and CNVIILTF. The significance of patient positioning may reflect the impact of learning curve as only the first 91 patients were operated on using the lateral "park-bench" position. An independent impact on CNVII-LTF was exerted by the perioperative use of nimodipine.
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Affiliation(s)
- Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Anna Podgórska
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Arkadiusz Nowak
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Czernicki
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Cole T, Veeravagu A, Zhang M, Azad T, Swinney C, Li GH, Ratliff JK, Giannotta SL. Retrosigmoid Versus Translabyrinthine Approach for Acoustic Neuroma Resection: An Assessment of Complications and Payments in a Longitudinal Administrative Database. Cureus 2015; 7:e369. [PMID: 26623224 PMCID: PMC4659577 DOI: 10.7759/cureus.369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Object Retrosigmoid (RS) and translabyrinthine (TL) surgery remain essential treatment approaches for symptomatic or enlarging acoustic neuromas (ANs). We compared nationwide complication rates and payments, independent of tumor characteristics, for these two strategies. Methods We identified 346 and 130 patients who underwent RS and TL approaches, respectively, for AN resection in the 2010-2012 MarketScan database, which characterizes primarily privately-insured patients from multiple institutions nationwide. Results Although we found no difference in 30-day general neurological or neurosurgical complication rates, in TL procedures there was a decreased risk for postoperative cranial nerve (CN) VII injury (20.2% vs 10.0%, CI 0.23–0.82), dysphagia (10.4% vs 3.1%, CI 0.10–0.78), and dysrhythmia (8.4% vs 2.3%, CI 0.08–0.86). Overall, there was no difference in surgical repair rates of CSF leak; however, intraoperative fat grafting was significantly higher in TL approaches (19.8% vs 60.2%, CI 3.95–9.43). In patients receiving grafts, there was a trend towards a higher repair rate after RS approach, while in those without grafts, there was a trend towards a higher repair rate after TL approach. Median total payments were $16,856 higher after RS approaches ($67,774 vs $50,918, p < 0.0001), without differences in physician or 90-day postoperative payments. Conclusions Using a nationwide longitudinal database, we observed that the TL, compared to RS, approach for AN resection experienced lower risks of CN VII injury, dysphagia, and dysrhythmia. There was no significant difference in CSF leak repair rates. The payments for RS procedures exceed payments for TL procedures by approximately $17,000. Data from additional years and non-private sources will further clarify these trends.
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Affiliation(s)
- Tyler Cole
- Medical Student, Stanford University School of Medicine
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine
| | - Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine
| | - Tej Azad
- Department of Neurosurgery, Stanford University School of Medicine
| | | | - Gordon H Li
- Department of Neurosurgery, Stanford University School of Medicine
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine
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Mendelsohn D, Westerberg BD, Dong C, Akagami R. Clinical and Radiographic Factors Predicting Hearing Preservation Rates in Large Vestibular Schwannomas. J Neurol Surg B Skull Base 2015; 77:193-8. [PMID: 27175312 DOI: 10.1055/s-0035-1564054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/22/2015] [Indexed: 01/06/2023] Open
Abstract
Objectives Postoperative hearing preservation rates for patients with large vestibular schwannomas range from 0 to 43%. The clinical and radiographic factors predicting hearing preservation in smaller vestibular schwannomas are well described; however, their importance in larger tumors is unclear. We investigated factors predicting hearing preservation in large vestibular schwannomas. Design Retrospective review. Setting Quaternary care academic center. Participants A total of 85 patients with unilateral vestibular schwannomas > 3 cm underwent retrosigmoid resections. Main Outcomes Measures Preoperative and postoperative serviceable hearing rates. Methods Clinical and radiographic data including preoperative and postoperative audiograms, preoperative symptoms, magnetic resonance imaging features, and postoperative facial weakness were analyzed. Results Hearing was preserved in 41% of patients (17 of 42) with preoperative serviceable hearing. Hypertension and diabetes increased the likelihood of preoperative hearing loss. Preoperative tinnitus predicted a lower likelihood of hearing preservation. No radiographic factors predicted hearing preservation; however, larger tumor size, smaller fourth ventricular width, and the presence of a cerebrospinal fluid cleft surrounding the tumor predicted postoperative facial weakness. Conclusion Systemic comorbidities may influence hearing loss preoperatively in patients with large vestibular schwannomas. The absence of tinnitus may reflect hearing reserve and propensity for hearing preservation. Preoperative radiographic features did not predict hearing preservation despite some associations with postoperative facial weakness.
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Affiliation(s)
- Daniel Mendelsohn
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian D Westerberg
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles Dong
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryojo Akagami
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Kunert P, Dziedzic T, Podgórska A, Czernicki T, Nowak A, Marchel A. Surgery for sporadic vestibular schwannoma. Part III: Facial and auditory nerve function. Neurol Neurochir Pol 2015; 49:373-80. [PMID: 26652871 DOI: 10.1016/j.pjnns.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this analysis was to assess short-term and long-term outcomes with respect to the preservation of facial and auditory nerve function following surgery for sporadic vestibular schwannomas. MATERIAL AND METHODS The study included 220 consecutive patients operated on with the retrosigmoid (217) or translabyrinthine (3) approach. The mean extrameatal diameter of the tumor was 30mm. In 217 patients, gross total resection was performed and near-total in 3. Before surgery, the facial nerve (CNVII) weakness was found in 18% of patients and only 20% had serviceable hearing. Intraoperative neurophysiological CNVII monitoring was routinely used (the last 211 procedures). Intraoperative monitoring of the cochlear nerve function was used when the preservation of hearing was attempted (45 procedures). RESULTS The rate of CNVII continuity loss during surgery was 11%, however, this decreased to 6% in the second half of the series. Facial nerve function deteriorated, in 88% of the patients shortly after surgery. However, it improved in 87% in follow-up. Delayed CNVII palsy was found in 5% of the patients and had a good prognosis in 88%. Final satisfactory CNVII function (CNVII-SF, HB grades I-III) was achieved in 76% of the patients when excluding the anastomosis results, and 87% when including them. In recent years, the rate of CNVII-SF has risen to 94%. Non-serviceable hearing was preserved in 49% of the patients, on whom it was attempted. CONCLUSION Considering the size of the tumors and extent of the resections, the preservation of CNVII function is currently very high. A close surveillance of CNVII function evolution following surgery is mandatory, as 2/3 of the patients discharged with deep paresis will need different face reanimation procedures. The preservation of useful hearing is still problematic, especially in patients with large tumors.
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Affiliation(s)
- Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland
| | - Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland.
| | - Anna Podgórska
- Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland
| | - Tomasz Czernicki
- Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland
| | - Arkadiusz Nowak
- Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland
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Wei PH, Qi ZG, Chen G, Hu P, Li MC, Liang JT, Guo HC, Ling F, Bao YH. Identification of cranial nerves near large vestibular schwannomas using superselective diffusion tensor tractography: experience with 23 cases. Acta Neurochir (Wien) 2015; 157:1239-49. [PMID: 25948078 DOI: 10.1007/s00701-015-2431-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The preservation of the facial nerve (FN) and acoustic function in large vestibular schwannoma (VS) surgery is challenging because of nerve course uncertainties and morphological deviations. Preoperative diffusion tensor tractography (DTT) has been proposed to predict the FN location. This study was conducted to evaluate the effectiveness of this technique for identifying the FN, cochlear nerve (CN) and trigeminal nerve (TN) in large VSs. METHODS The study included 23 consecutive patients with VS of Hannover classification T3b to T4b from November 2013 through May 2014. Diffusion tensor images and anatomical images were acquired. The DTT images of the cranial nerves were extracted before surgery for each patient to determine the relationships of these nerves with the tumor. The results were then validated during the tumorectomy. RESULTS In 21 (91.30%) patients, the location of the FN on the DTT images agreed with the intraoperative findings, including in 2 patients in whom the FN passed through the interface between the parenchyma and the cystic changes and in 3 patients with a membranoid FN. The CN or fibers of unclear function were observed on DTT images in four patients with functional hearing. One penetrating fiber of unknown function was effectively constructed. The TN was accurately detected on the DTT images for all patients. CONCLUSIONS DTT effectively revealed the location of the FN, including cases in which the FN was membranoid or passed through the interface between an area exhibiting cystic changes and the tumor nodule. Fibers aside from the FN and the TN were revealed by DTT in patients who retained functional hearing. Penetrating fibers were also found using DTT. This technique can be useful during VS resection.
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Paderno A, Piazza C, Nicolai P. Recent advances in surgical management of parapharyngeal space tumors: . Curr Opin Otolaryngol Head Neck Surg 2015; 23:83-90. [DOI: 10.1097/moo.0000000000000134] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Adele Wirch
- Electroneurodiagnostics University of Washington Medical Center Seattle, Washington
| | - Donald Farrell
- Department of Neurology University of Washington Seattle, Washington
| | - Gerald Grant
- Department of Neurological Surgery University of Washington, Harborview Medical Center Seattle, Washington
| | - John D. Loeser
- Departments of Neurological Surgery and Anesthesiology University of Washington Seattle, Washington
| | - Marc Mayberg
- Department of Neurological Surgery The Cleveland Clinic Foundation Cleveland, Ohio
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Sepehrnia A, Borghei-razavi H. Vestibular schwannoma between 1 and 3cm: Importance of the tumor size in surgical and functional outcome. Clin Neurol Neurosurg 2015; 129:21-6. [DOI: 10.1016/j.clineuro.2014.11.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/15/2014] [Accepted: 11/27/2014] [Indexed: 11/20/2022]
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Wang W, Yang C, Li Q, Li W, Yang X, Zhang YX. Masseter-to-Facial Nerve Transfer: A Highly Effective Technique for Facial Reanimation After Acoustic Neuroma Resection. Ann Plast Surg 2014; 73:S63-9. [DOI: 10.1097/sap.0000000000000246] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Betka J, Zvěřina E, Balogová Z, Profant O, Skřivan J, Kraus J, Lisý J, Syka J, Chovanec M. Complications of microsurgery of vestibular schwannoma. Biomed Res Int 2014; 2014:315952. [PMID: 24987677 PMCID: PMC4058457 DOI: 10.1155/2014/315952] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/29/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to analyze complications of vestibular schwannoma (VS) microsurgery. MATERIAL AND METHODS A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup. RESULTS In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225) removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III-VI) was observed in 124 cases (45%) immediately after surgery and in 104 cases (33%) on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX-XI) deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%), headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis. CONCLUSIONS Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.
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Affiliation(s)
- Jan Betka
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles University in Prague, V Uvalu 84, Prague 5, 150 06 Prague, Czech Republic
| | - Eduard Zvěřina
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles University in Prague, V Uvalu 84, Prague 5, 150 06 Prague, Czech Republic
| | - Zuzana Balogová
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles University in Prague, V Uvalu 84, Prague 5, 150 06 Prague, Czech Republic
- Department of Auditory Neuroscience, Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Videnska 1083, Prague 4, 142 20 Prague, Czech Republic
| | - Oliver Profant
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles University in Prague, V Uvalu 84, Prague 5, 150 06 Prague, Czech Republic
- Department of Auditory Neuroscience, Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Videnska 1083, Prague 4, 142 20 Prague, Czech Republic
| | - Jiří Skřivan
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles University in Prague, V Uvalu 84, Prague 5, 150 06 Prague, Czech Republic
| | - Josef Kraus
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Faculty Hospital Motol, Charles University in Prague, V Uvalu 84, Prague 5, 150 06 Prague, Czech Republic
| | - Jiří Lisý
- Department of Imaging Methods, 2nd Faculty of Medicine, Faculty Hospital Motol, Charles University, V Uvalu 84, Prague 5 150 06, Prague, Czech Republic
| | - Josef Syka
- Department of Auditory Neuroscience, Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Videnska 1083, Prague 4, 142 20 Prague, Czech Republic
| | - Martin Chovanec
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles University in Prague, V Uvalu 84, Prague 5, 150 06 Prague, Czech Republic
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Sampath P, Rhines L, Goel R, Long DM. Cranial nerve preservation in contemporary vestibular schwannoma (acoustic neuroma) treatment. ACTA ACUST UNITED AC 1998; 8:86-96. [DOI: 10.1007/s003290050065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Acioly MA, Liebsch M, de Aguiar PHP, Tatagiba M. Facial Nerve Monitoring During Cerebellopontine Angle and Skull Base Tumor Surgery: A Systematic Review from Description to Current Success on Function Prediction. World Neurosurg 2013; 80:e271-300. [DOI: 10.1016/j.wneu.2011.09.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 09/06/2011] [Indexed: 11/17/2022]
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Yamakami I, Uchino Y, Kobayashi E, Yamaura A. Conservative management, gamma-knife radiosurgery, and microsurgery for acoustic neurinomas: A systematic review of outcome and risk of three therapeutic options. Neurol Res 2013; 25:682-90. [PMID: 14579782 DOI: 10.1179/016164103101202075] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Conservative management, gamma-knife (GK) radiosurgery, and microsurgery are therapeutic options for acoustic neurinomas (ANs). To determine the outcomes and risks of these methods this systematic review analyzed data from 903 patients with conservative management, 1475 with GK radiosurgery, and 5005 with microsurgery from 38 studies identified in MEDLINE searches. Conservative management over a 3.1-year period showed that 51% of ANs showed a tumor growth, an average tumor growth rate was 1.87 mm year-1, 20% of ANs ultimately required surgical intervention, and a third of the patients lost useful hearing. GK radiosurgery significantly reduced the percentage of ANs that enlarged, to 8%, and reduced the percentage that underwent microsurgery to 4.6% over a 3.8-year period. Microsurgery removed 96% of ANs totally, with tumor recurrence, mortality, and major disability rates of 1.8%, 0.63%, and 2.9%, respectively. The majority of ANs grow slowly, but ultimately require intervention. Carrying the risk of hearing loss, conservative management should be supplemented with close follow-up. With a low rate of morbidity, GK radiosurgery suppresses tumor growth and provides good tumor control. Microsurgery provides the best tumor control, although mortality and morbidity are not completely eliminated.
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Affiliation(s)
- Iwao Yamakami
- Department of Neurosurgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba, Japan 260-8670.
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Starmer HM, Ward BK, Best SR, Gourin CG, Akst LM, Hillel A, Brem H, Francis HW. Patient-perceived long-term communication and swallow function following cerebellopontine angle surgery. Laryngoscope 2013; 124:476-80. [DOI: 10.1002/lary.24252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/22/2013] [Accepted: 05/22/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Heather M. Starmer
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
| | - Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
| | - Simon R.A. Best
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
| | - Lee M. Akst
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
| | - Alexander Hillel
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
| | - Henry Brem
- Department of Neurosurgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
| | - Howard W. Francis
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institution; Baltimore Maryland U.S.A
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Sharma M, Sonig A, Ambekar S, Nanda A. Radiological and Clinical Factors Predicting the Facial Nerve Outcome following Retrosigmoid Approach for Large Vestibular Schwannomas (VSs). J Neurol Surg B Skull Base 2013; 74:317-23. [PMID: 24436931 DOI: 10.1055/s-0033-1349060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022] Open
Abstract
Objective The aim of our study was to identify the radiological and clinical factors that predict postoperative facial nerve outcome following retrosigmoid approach for large vestibular schwannomas (VSs). Methods A total of 72 patients with large (≥ 3 cm) vestibular schwannomas was included in this retrospective study. Various parameters evaluated were age, gender, clinical presentation, tumor diameter in three planes, intrameatal extension, and pattern of growth. Results Age of the patient and presenting symptoms such as headache, ataxia, or preoperative facial nerve dysfunction correlated with poorer facial nerve outcome (p < 0.05). Patients with larger tumor volumes and extrameatal growth experienced a worse outcome (p < 0.05). Anterior and caudal extension (p = 0.001) correlated with poorer outcome, as well. Intrameatal extension and bony changes of the internal acoustic meatus did not correlate with the outcome (p > 0.05). Of the various examined factors, preoperative facial nerve function independently predicted postoperative facial nerve outcome. Conclusion Our study suggests that young patients with small tumor volume and normal facial nerve function at presentation are more likely to experience a good postoperative facial nerve outcome. These clinical and radiological parameters can be used to predict facial nerve outcome prior to surgery.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Ashish Sonig
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Sudheer Ambekar
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA
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Zou P, Zhao L, Chen P, Xu H, Liu N, Zhao P, Lu A. Functional outcome and postoperative complications after the microsurgical removal of large vestibular schwannomas via the retrosigmoid approach: a meta-analysis. Neurosurg Rev 2013; 37:15-21. [PMID: 23771647 DOI: 10.1007/s10143-013-0485-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/16/2013] [Accepted: 05/05/2013] [Indexed: 01/08/2023]
Abstract
For large (≥30 mm) or giant (≥40 mm) vestibular schwannomas (VSs) for which microsurgical removal is the main treatment option, complete tumour resection and the preservation of acceptable facial nerve function can be safely and successfully achieved via the retrosigmoid approach. We performed a meta-analysis to provide a reliable estimate of functional outcome and postoperative complications for patients treated surgically for large VSs. We conducted a comprehensive search in Pubmed, Embase and the Chinese National Knowledge Infrastructure (CNKI) databases to identify publications that included only patients in whom the VSs were >3.0 cm in maximal diameter and microsurgically removed by a retrosigmoid approach. Pooled estimates of proportions with corresponding 95 % confidence intervals were calculated using the Freeman-Tukey double arcsine transformation. This meta-analysis revealed that the pooled proportion of gross total resections was 79.1 % (95 % CI, 64.2-90.8 %; I (2) = 95.4 %). By combining microsurgical techniques with continuous electrophysiological monitoring, the anatomical preservation of the facial nerve at the end of surgery was achieved in 88.8 % (95 % CI, 83.6-93.2 %; I (2) = 76.1 %) of the patients. The pooled proportion of good postoperative facial nerve function (House-Brackmann (HB) grades I-II) was 62.9 % (95 % CI, 50.0-74.9 %; I (2) = 91.1 %). Cerebrospinal fluid leakage was reported in 7.8 % (95 % CI, 4.8-11.4 %; I (2) = 49.8 %) of the patients. The mortality rate was 0.87 % (95 % CI, 0.22-1.78 %; I (2) = 4.9 %). Our meta-analysis revealed that for large VSs, very favourable results can be obtained using the retrosigmoid approach with minimal mortality, especially with respect to anatomical and functional facial nerve preservation.
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Affiliation(s)
- Peng Zou
- Department of neurosurgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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