scholarly journals Applicability of contemporary quality indicators in vestibular surgery—do they accurately measure tumor inherent postoperative complications of vestibular schwannomas?

2021 ◽  
Author(s):  
Stephanie Schipmann ◽  
Sebastian Lohmann ◽  
Bilal Al Barim ◽  
Eric Suero Molina ◽  
Michael Schwake ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Facial Nerve ◽  
Hearing Impairment ◽  
Quality Indicators ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Care Delivery ◽  
Csf Leak ◽  
Neurosurgical Procedures

Abstract Background Due to rising costs in health care delivery, reimbursement decisions have progressively been based on quality measures. Such quality indicators have been developed for neurosurgical procedures, collectively. We aimed to evaluate their applicability in patients that underwent surgery for vestibular schwannoma and to identify potential new disease-specific quality indicators. Methods One hundred and three patients operated due to vestibular schwannoma were subject to analysis. The primary outcomes of interest were 30-day and 90-day reoperation, readmission, mortality, nosocomial infection and surgical site infection (SSI) rates, postoperative cerebral spinal fluid (CSF) leak, facial, and hearing function. The secondary aim was the identification of prognostic factors for the mentioned primary outcomes. Results Thirty-day (90-days) outcomes in terms of reoperation were 10.7% (14.6%), readmission 9.7% (13.6%), mortality 1% (1%), nosocomial infection 5.8%, and SSI 1% (1%). A 30- versus 90-day outcome in terms of CSF leak were 6.8% vs. 10.7%, new facial nerve palsy 16.5% vs. 6.1%. Hearing impairment from serviceable to non-serviceable hearing was 6.8% at both 30- and 90-day outcome. The degree of tumor extension has a significant impact on reoperation (p < 0.001), infection (p = 0.015), postoperative hemorrhage (p < 0.001), and postoperative hearing loss (p = 0.026). Conclusions Our data demonstrate the importance of entity-specific quality measurements being applied even after 30 days. We identified the occurrence of a CSF leak within 90 days postoperatively, new persistent facial nerve palsy still present 90 days postoperatively, and persisting postoperative hearing impairment to non-serviceable hearing as potential new quality measurement variables for patients undergoing surgery for vestibular schwannoma.

IncobotulinumtoxinA (Xeomin®) in delayed facial nerve palsy developing after vestibular schwannoma resection

Toxicon ◽  
2018 ◽  
Vol 156 ◽  
pp. S2
Author(s):  
Mihail Akulov ◽  
Olga Orlova ◽  
Aleksandra Orlova ◽  
Alexey Tomskiy ◽  
Dmitriy Usachev ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy

Hearing impairment and facial palsy as initial signs of Wegener's granulomatosis

1980 ◽  
Vol 94 (6) ◽  
pp. 649-657 ◽  
Author(s):  
I. H. Calonius ◽  
C. K. Christensen
Keyword(s):  
Facial Nerve ◽  
Hearing Impairment ◽  
Otitis Media ◽  
Wegener’S Granulomatosis ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Wegener's Granulomatosis ◽  
The Other ◽  
Treatment Resistant ◽  
Serous Otitis Media

SummaryIn two patients with Wegener's granulomatosis, treatment-resistant serous otitis media was followed by unilateral facial nerve palsy. Later both patients developed uraemia due to extracapillary glomerulonephritis. In one of them, who was treated with prednisone and cyclophosphamide, renal function improved, while in the other patient it remained impaired. Both patients suffered lasting hearing impairment in spite of general improvement during the course of the disease. The facial nerve palsy improved slightly in one, while no improvement was seen in the other.The possibility of Wegener's granulomatosis or other autoimmune collagen diseases should be considered in cases of treatment-resistant serous otitis media. Early diagnosis and treatment can possibly save the patient from the lifethreatening consequences of these diseases.

scholarly journals Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy

2017 ◽  
Vol 79 (03) ◽  
pp. 309-313 ◽  
Author(s):  
Michael Mooney ◽  
Benjamin Hendricks ◽  
Christina Sarris ◽  
Robert Spetzler ◽  
Randall Porter ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Tumor Diameter ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Microsurgical Resection ◽  
Grade Iii

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.

scholarly journals Nervus intermedius dysfunctions after vestibular schwannoma surgery: a prospective clinical study

2019 ◽  
Vol 131 (2) ◽  
pp. 555-560 ◽  
Author(s):  
Hussam Metwali ◽  
Katja Kniese ◽  
Babak Kardavani ◽  
Venelin Gerganov ◽  
Madjid Samii
Keyword(s):  
Facial Nerve ◽  
Prospective Study ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Nasal Secretion ◽  
Prospective Clinical Study ◽  
Taste Sensation ◽  
Nervus Intermedius

OBJECTIVEThe purpose of this prospective study was to evaluate the dysfunction of the nervus intermedius (NI) after vestibular schwannoma (VS) surgery. The authors present a clinically feasible method for this purpose.METHODSIn this prospective study, the authors included 30 patients who underwent surgery at the International Neuroscience Institute between May 2014 and February 2017 for resection of VS. The patients’ taste sensation was examined using taste strips. Lacrimation was tested using the Schirmer I test. The clinical evaluation was performed before surgery and repeated at 2 weeks and at 6 months after surgery as well as during the follow-up, which extended up to 2 years. The authors tested the correlation between the NI dysfunctions and the House-Brackmann grade of facial nerve palsy.RESULTSThe taste sensation was lost on the side of surgery in 2 patients (6.6%) and decreased in 4 patients (13.3%). The disturbance of taste sensation was not statistically correlated with dysfunctions of the motor portion of the facial nerve. The taste impairment resolved in 4 patients within 6 months, but 2 patients suffered from persistent loss of the taste sensation on the side of surgery during the follow-up. In 23 patients (76.6%), the baseline lacrimation was lower on the side of surgery, and it was significantly correlated with outcome for dysfunctions of the motor portion of the facial nerve. During the follow-up, baseline lacrimation improved in correlation with the improvement in the dysfunctions of the motor portion of the facial nerve. None of the patients reported change in salivation or nasal secretion.CONCLUSIONSThe NI can be affected after VS surgery. The disturbance of baseline lacrimal secretion was correlated with dysfunctions of the motor portion of the facial nerve. However, the disturbance of the taste sensation was not correlated with the grade of facial nerve palsy. Dysfunctions of the NI should be evaluated and separately reported while analyzing facial nerve outcome after VS surgery.

Facial nerve palsy after vestibular schwannoma surgery: Dynamic risk-stratification based on continuous EMG-monitoring

2014 ◽  
Vol 125 (2) ◽  
pp. 415-421 ◽  
Author(s):  
Julian Prell ◽  
Christian Strauss ◽  
Jens Rachinger ◽  
Alex Alfieri ◽  
Christian Scheller ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Dynamic Risk

scholarly journals Delayed facial nerve palsy after vestibular schwannoma surgery

2018 ◽  
Vol 20 (1) ◽  
pp. 84-88
Author(s):  
Walter J. Fagundes Pereyra ◽  
Alonso Luis De Sousa ◽  
Karlo Faria Nunes ◽  
Deborah Nunes De Angeli
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Surgical Removal ◽  
Electromyographic Activity ◽  
Immunological Study ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Dysfunction

Background: Facial nerve dysfunction may occur immediately after vestibular schwanoma surgery. Electromyographyc monitoring of motor cranial nerves during cerebellopontine angle surgery has become an essential tool. Although delayed onset of facial nerve dysfunction hours to months following vestibular schwanoma surgery are rare. Case description: We describe the case of a 70-years-old male who was admitted with a left side tinnitus and hearing loss of the last 3 years. Magnetic resonance imaging (MRI) T1-weighted demonstrated an isointensity lesion, 30mm in diameter, at the left cerebello-pontine angle with a small portion in the internal auditory canal. The patient was surgically treated by means of a standart suboccipital retrosigmoid approach. The facial nerve was monitored by continuously during surgery. Surgical removal was macroscopically complete. The facial nerve was well-preserved during surgery and showed at the end of the procedure normal electromyographic activity. The patient did well postoperatively and was discharged at the 4th postoperative day and facial function was normal (House-Brackmann grade I). On the 10th postoperative day he notices difficult closing his left eye that progressed to complete facial nerve palsy (House-Brackmann grade III). Steroid therapy was performed for five days associated with physical therapy. One month later his facial nerve function had completely recovered. After six months, the patient remains asymptomatic and neurologically intact. MRI obtained at the 16th postoperative day showed intense enhancement of the intracranial facial nerve segment and also demonstrated no residual tumor. Immunological study at the time of onset showed herpes simplex virus antibody titer normal as well as those for herpes zoster virus. Conclusions: Delayed facial nerve palsy remains an under reported and consequently not very known phenomenon in the neurosurgical practice and literature. Because of the 2009favorable rate of recovery, patients should be reassured in the interim and should not undergo any corrective surgical procedures to improve facial nerve function. Delayed facial nerve palsy is uncommon after vestibular schwannoma surgery. Excellent recovery of facial nerve function to the original postoperative status nearly always occurs in those circumstances.

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