Facial nerve sacrifice in lateral approaches to the skull base: Simultaneous reconstruction by graft interposition

OBJECTIVEThe aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries.METHODSThe authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system.RESULTSTwo hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002).CONCLUSIONSCable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue–aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.

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Endoscopic Removal of Skull Base Chordoma Type III through Single Skull Base Approach: Our Early Experience

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i1.42926 ◽

2019 ◽

Vol 9 (1) ◽

pp. 57-63

Author(s):

Shamsul Alam ◽

Mohammad Sujan Sharif ◽

Rathin Haldar ◽

Anil Chaudhury ◽

Abdullah Al Mahbub ◽

...

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Cranial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Lower Cranial Nerve ◽

Base Approach ◽

Type Iii ◽

Skull Base Approach ◽

Skull Base Chordoma

Introduction: Skull base chordomas present with headache, commonly VI cranial nerve palsy or sometimes with lower cranial nerve involvement.Sometimes in neglected case it presents with complete blindness and facial nerve palsy. Case presentation: A 60-year old man presented with headache,visual disturbance progressing to blindness and facial nerve palsy. At first, radiological imaging showed large tumor which eroded his clivus, sella floor and involved both cavernous carotid more on left side,both ethmoid sinus,middle cranial fossa entension with transdural extension posteriorly. Conclusion: Patients who present with complete blindness and facial nerve palsy, endoscopic excision in a single skull base approach of a skull base chordoma type III is challenging and who developed visual improvement following surgery, has been highlighted in this report. Bang. J Neurosurgery 2019; 9(1): 57-63

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Transtemporal Approach to the Skull Base: An Anatomical Study

Neurosurgery ◽

10.1227/00006123-198611000-00014 ◽

1986 ◽

Vol 19 (5) ◽

pp. 799-808 ◽

Cited By ~ 64

Author(s):

N. Sekhar Laligam ◽

Estonillo Rodrigo

Keyword(s):

Facial Nerve ◽

Vertebral Artery ◽

Skull Base ◽

Medial Temporal Lobe ◽

Case Reports ◽

Cranial Nerves ◽

Sigmoid Sinus ◽

Anterior Surface ◽

Advantages And Disadvantages ◽

Dural Opening

Abstract The surgical anatomy of a transtemporal approach to the structures of the clivus was defined with the aid of dissections in 10 cadaver heads. The steps in the dissection consisted of first exposing the cervical internal carotid artery (ICA), the internal jugular vein, and the caudal cranial nerves, each at the skull base; then performing small retromastoid and temporal craniotomies; and, finally, drilling away the petrous and tympanic bone to expose the intratemporal parts of the facial nerve, the petrous ICA, the sigmoid sinus, and the jugular bulb. To expose the structures of the lower clivus, the sigmoid sinus was ligated and divided, the facial nerve was displaced anterosuperiorly, and the inner ear structures were preserved. Dural opening exposed the anterolateral and anterior surfaces of the medulla, the pontomedullary junction, and the spinomedullary junction. The ipsilateral vertebral artery and often the contralateral vertebral artery and the vertebrobasilar junction, the caudal cranial nerves, and the origin of the 6th, 7th, and 8th cranial nerves were well exposed. To expose the structures of the middle clivus, we drilled away the labyrinth, the cochlea, and a portion of the clival bone. The facial nerve was displaced posteroinferiorly. Dural opening exposed the ipsilateral anterior surface of the pons, the midbasilar artery, and the ipsilateral 5th, 6th, 7th, and 8th cranial nerves. A portion of the contralateral anterior surface of the pons was also exposed at times. The superior limit of this exposure was just above the origin of the trigeminal nerve. The exposure of the upper clival structures was limited with this approach, and required medial temporal lobe retraction. Two case reports are included to illustrate the application of the transtemporal approach to the exposure and clipping of aneurysms of the vertebrobasilar system. The advantages and disadvantages of this approach are discussed.

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Management of the Facial Nerve with Lateral Skull Base Tumors

Otology & Neurotology ◽

10.1097/00129492-200200001-00120 ◽

2002 ◽

Vol 23 (Sup 1) ◽

pp. S47

Author(s):

John P. Leonetti ◽

Doug Anderson ◽

Sam Marzo ◽

Guy Petruzelli ◽

Darl Van Devender

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Skull Base Tumors ◽

Lateral Skull Base

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End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face

Journal of Neurosurgery ◽

10.3171/jns.2006.104.3.457 ◽

2006 ◽

Vol 104 (3) ◽

pp. 457-460 ◽

Cited By ~ 19

Author(s):

Stefano Ferraresi ◽

Debora Garozzo ◽

Vittorino Migliorini ◽

Paolo Buffatti

Keyword(s):

Facial Nerve ◽

Cranial Nerve ◽

Orbicularis Oculi Muscle ◽

Orbicularis Oculi ◽

Fascial Sling ◽

The Face ◽

Gold Weight ◽

A New Technique ◽

12Th Cranial Nerve ◽

Graft Interposition

✓ The aim of this paper was to report on further experience with a new technique for reanimation of the facial nerve. This procedure allows a straight end-to-side hypoglossal–facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition. It is technically demanding and time consuming but offers an effective, reliable, and extraordinarily quick means of reinnervating the facial muscles, including the orbicularis oculi muscle, thus avoiding the need for a gold weight in the eyelid or a fascial sling.

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Skull base CT: normative values for size and symmetry of the facial nerve canal, foramen ovale, pterygoid canal, and foramen rotundum

Surgical and Radiologic Anatomy ◽

10.1007/s00276-012-1001-4 ◽

2012 ◽

Vol 35 (1) ◽

pp. 19-24 ◽

Cited By ~ 21

Author(s):

Ali R. Sepahdari ◽

Sandy Mong

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Normative Values ◽

Foramen Ovale ◽

Facial Nerve Canal ◽

Pterygoid Canal ◽

Foramen Rotundum

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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

Frontiers in Bioengineering and Biotechnology ◽

10.3389/fbioe.2021.659413 ◽

2021 ◽

Vol 9 ◽

Author(s):

Isabel C. Hostettler ◽

Narayan Jayashankar ◽

Christos Bikis ◽

Stefan Wanderer ◽

Edin Nevzati ◽

...

Keyword(s):

New Zealand ◽

Facial Nerve ◽

Skull Base ◽

Clinical Studies ◽

Cerebellopontine Angle ◽

Experimental Studies ◽

Experimental Models ◽

Current Evidence ◽

Tumor Surgery ◽

New Zealand White Rabbits

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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