Facial palsy after glomus jugulare tumour embolization

1999 ◽  
Vol 113 (3) ◽  
pp. 268-270 ◽  
Author(s):  
Nikolaos Marangos ◽  
Martin Schumacher
Keyword(s):  
Polyvinyl Alcohol ◽  
Facial Nerve ◽  
Facial Palsy ◽  
Rare Complication ◽  
Middle Meningeal Artery ◽  
Tumour Removal ◽  
Complete Tumour ◽  
Glomus Jugulare Tumour ◽  
Facial Function ◽  
Meningeal Artery

AbstractFacial palsy after pre-operative embolization of glomus tumours is a rare complication. In our case, complete facial palsy occurred within four hours after embolization with polyvinyl alcohol foam. Three days later, embolization material was found in the perineural vessels of the facial nerve in its mastoidal segment. Six months after complete tumour removal, facial decompression with perineural incision, and steroid therapy, facial function recovered completely. In cases of embolization of both stylomastoid and branches of the middle meningeal artery with resorbable material, temporary facial palsy can occur.

Persistence of the Stapedial Artery: A Histopathologic Study

1985 ◽  
Vol 93 (3) ◽  
pp. 298-312 ◽  
Author(s):  
Mitchell Marion ◽  
Raúl Hinojosa ◽  
Anwar A. Khan
Keyword(s):  
Facial Nerve ◽  
Clinical Significance ◽  
Rare Event ◽  
Middle Meningeal Artery ◽  
The Third ◽  
Histopathologic Study ◽  
Stapedial Artery ◽  
Developmental Theories ◽  
Temporal Bones ◽  
Meningeal Artery

Persistence of the stapedial artery is a rare event. Fewer than 30 cases have been reported since the discovery of this artery in 1836. We carried out a histopathologic study on three temporal bones from two patients who had this anomaly, and were able to trace the full course of the artery. In two specimens a large stapedial artery persisted and substituted for the middle meningeal artery. In the third, a small, persistent stapedial artery ended in the arterial plexus surrounding the facial nerve. Persistence is discussed in terms of embryogenesis, developmental theories, histologic findings, and clinical significance. The material suggests that the stapedial artery can persist to varying degrees

Intraspinosum Middle Meningeal Artery Ligation: A Simple Technique to Control Bleeding in the Middle Fossa During the Anterior Transpetrosal Approach

2017 ◽  
Vol 13 (2) ◽  
pp. 163-172
Author(s):  
Shunsuke Shibao ◽  
Hamid Borghei-Razavi ◽  
Kazunari Yoshida
Keyword(s):  
Facial Nerve ◽  
Histological Study ◽  
Middle Meningeal Artery ◽  
Mandibular Nerve ◽  
Petrous Apex ◽  
Middle Fossa ◽  
Foramen Ovale ◽  
Anterior Transpetrosal Approach ◽  
Nerve Paresis ◽  
Meningeal Artery

Abstract BACKGROUND: Although the greater superficial petrosal nerve (GSPN) is an important landmark of the anterior transpetrosal approach (ATPA), bleeding from the interdural space around the foramen spinosum (FS), the GSPN, and the foramen ovale impedes the identification of the GSPN, during epidural dissection in the ATPA. OBJECTIVE: To describe the technique of intraspinosum middle meningeal artery (MMA) ligation, which enables us to control bleeding from the interdural space. METHODS: During epidural dissection, we identified the FS and partially drilled the lateral side of the FS. Next, we cut the convergence site of the neurovascular structures such as the MMA, middle meningeal vein, and the meningeal branch of the mandibular nerve with the periosteal dura within the FS and continued dural detachment epidurally to expose the petrous apex. Bleeding control around the FS and postoperative facial nerve paresis were assessed for 96 patients treated with the ATPA. Additionally, histological study was performed around the FS using Masson's trichrome stain. RESULTS: In all cases, in which this technique was used, bleeding from the interdural space was well controlled and no persistent facial nerve paresis was identified. In the histological study, we confirmed that the MMA, the middle meningeal vein, and the meningeal branch of the mandibular nerve converged into the FS and many venous channels existed in the interdural space around the FS and the foramen ovale. CONCLUSION: Intra-FS MMA ligation is an effective method for control of bleeding from the interdural space of the middle fossa during the ATPA.

S230 – MRI Findings in Delayed Facial Palsy after Stapedectomy

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P152-P152 ◽  
Author(s):  
Marc Cohen ◽  
Claudia Kirsch ◽  
Abie Mendelsohn ◽  
Akira Ishiyama
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Rare Complication ◽  
Internal Auditory Canal ◽  
Facial Nerve Paralysis ◽  
Mri Findings ◽  
Nerve Paralysis ◽  
Oral Corticosteroids ◽  
Magnetic Resonance Imaging Mri

Objectives 1) To retrospectively review the pathophysiology and radiologic features of delayed facial palsy after stapedectomy. 2) To discuss the management strategy of this unusual problem. Methods 450 stapedectomies performed at our institution were retrospectively reviewed from 1997 to 2007. A total of 2 patients in this series developed a delayed facial paralysis postoperatively. The clinical presentation, radiographic characteristics on magnetic resonance imaging (MRI), and the management of these patients are presented. Results A total of 2 patients out of 450 stapedectomies within a 10-year period developed the rare complication of delayed facial paralysis (postoperative days 12 and 41, respectively). Both patients developed rapidly progressive complete facial nerve paralysis preceded by periauricular pain and dysguesia. No sign of infection was present in the operated ear. MRI with gadolinium of the internal auditory canal demonstrated gadolinium enhancement of the labyrinthine portion of the facial nerve as seen in Bell's palsy. Both patients were treated with oral corticosteroids and antiviral medications. Subsequent imaging revealed decreased enhancement of the facial nerve with complete resolution of facial paralysis. Conclusions In the rare complication of delayed facial paralysis after stapedectomy, MR imaging is a useful diagnostic tool to dictate the treatment strategy. Delayed facial paralysis following stapedectomy can be treated medically when the MRI scan demonstrates enhancement of the facial nerve in the labyrinthine segment.

scholarly journals Gamma Knife Surgery for Facial Nerve Schwannomas

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. 853-859 ◽  
Author(s):  
Claude F. Litre ◽  
Grégoire P. Gourg ◽  
Manabu Tamura ◽  
Driss Mdarhri ◽  
Adil Touzani ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Facial Palsy ◽  
Radical Resection ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Medium Size ◽  
Functional Evaluation ◽  
Facial Function

Abstract OBJECTIVE Radical resection of facial nerve schwannomas classically implies a high risk of severe facial palsy. Owing to the rarity of facial palsy after gamma knife surgery (GKS) of vestibular schwannomas, functional evaluation after GKS seems rational in this specific group of patients. To our knowledge, no previous similar evaluation exists in the literature. METHODS Of 1783 schwannomas of the cerebellopontine angles treated by GKS at Timone University Hospital between July 1992 and May 2003, 11 were diagnosed as originating from the facial nerve. Criteria for this diagnosis were the involvement of the tympanic or mastoid segment of the facial nerve (n = 9) and/or preoperative observation of a facial nerve deficit that had occurred during previous microsurgery (two patients). The rare occurrence of facial palsy after vestibular schwannoma radiosurgery, usually within 18 months of treatment, has been considered only in the patients with more than 2 years of follow-up (n = 9). RESULTS Six of these patients experienced a previous spontaneous facial palsy on one (n = 4) or several occasions (n = 2). A normal motor facial function was observed in only three patients before GKS (House-Brackmann Grade II in six patients, Grade III in one patient, Grade IV in one patient). The median follow-up period was 39 months (range, 18–84 mo). At the time of the last follow-up examination, no patients had developed a new facial palsy or experienced deterioration of a preexisting facial palsy and three patients had improvement of a preoperative facial palsy. Ten out of the 11 tumors are stable or decreased in size; in the other, a microsurgical resection of the tumor had been recommended owing to the development of a cyst. Clinical management owing to the specificity and heterogeneity of this group of patients has required the development of an original classification of four anatomic subtypes presenting different clinical and surgical difficulties. CONCLUSION This first study demonstrates that radiosurgery allows treatment of these patients while preserving normal motor facial function. Such an advantage should lead to the consideration of GKS as a first treatment option for small- to medium-size facial nerve schwannomas.

scholarly journals Endovascular Treatment of Hemifacial Spasm Associated with a Petrosal DAVF Using Transarterial Onyx Embolization

2012 ◽  
Vol 18 (1) ◽  
pp. 69-73 ◽  
Author(s):  
T. Li ◽  
X. Lv ◽  
Z. Wu
Keyword(s):  
Complete Remission ◽  
Facial Nerve ◽  
Endovascular Treatment ◽  
Hemifacial Spasm ◽  
Dural Arteriovenous Fistula ◽  
Middle Meningeal Artery ◽  
Vascular Compression ◽  
The Right ◽  
Meningeal Artery

This paper reports that decompression of the facial nerve by transarterial Onyx embolization may relieve hemifacial spasm (HFS) caused by dilated veins due to a right petrosal dural arteriovenous fistula (DAVF). A 56-year-old man suffered severe chronic right HFS associated with a dilated right petrosal vein lying in the vicinity of the facial nerve. The right petrosal DAVF was reached through the middle meningeal artery using a transfemoral arterial approach and was occluded with Onyx 18 (M.T.I.- ev3, Irvine, CA, USA). There was complete remission of HFS without recurrence after two months of follow-up. This case supports vascular compression in the pathogenesis of HFS and suggests that facial nerve injury caused by a DAVF could be treated with transarterial Onyx embolization.

Facial Nerve Paralysis Following Endovascular Embolization: A Case Report and Review of the Literature

2020 ◽  
pp. 000348942096661
Author(s):  
Austin Y. Feng ◽  
Michael C. Jin ◽  
Sandy Wong ◽  
Jon-Paul Pepper ◽  
Robert Jackler ◽  
...  
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Facial Palsy ◽  
Rare Complication ◽  
Relevant Literature ◽  
Complete Recovery ◽  
Endovascular Embolization ◽  
Additional Treatment ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis

Objective: We report a case of facial nerve paralysis post-endovascular embolization of a sigmoid sinus dural arterio-venous fistula from initial presentation to current management and discuss the merits of observation versus decompression through a systematic review of relevant literature. Patient: 61 F with right facial palsy Intervention: Following a single intravenous dexamethasone injection with oral steroids over 2 months, patient was observed with no additional treatment other than Botox chemodenervation and facial rehabilitation. Outcome and Results: The patient initially presented with complete right facial palsy (HB 6/6). Post-op CT imaging indicated Onyx (ev3, Irvine, California, USA) particles present at the geniculate segment of the facial nerve. Observation was chosen over surgical intervention. At the most current follow up of 8 months, facial function has improved substantially (HB 2/6). Conclusion: Facial palsy is a serious, though rare, complication of transarterial endovascular embolization. With our case report and literature review, we highlight not only how conservative observation is the recommended treatment, but also that facial nerve recovery should be expected to reach near complete recovery, but not sooner than in 3 months.

Blood Supply of the Facial Nerve in the Middle Fossa: The Petrosal Artery

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS297-ONS304 ◽  
Author(s):  
Hatem El-Khouly ◽  
Juan Fernandez-Miranda ◽  
Albert L. Rhoton
Keyword(s):  
Facial Nerve ◽  
Middle Cranial Fossa ◽  
Middle Meningeal Artery ◽  
Sole Source ◽  
Geniculate Ganglion ◽  
Nerve Supply ◽  
Middle Fossa ◽  
Greater Petrosal Nerve ◽  
Cranial Fossa ◽  
Meningeal Artery

Abstract Objective: To define the arterial supply to the facial nerve that crosses the floor of the middle cranial fossa. Methods: Twenty-five middle fossae from adult cadaveric-injected specimens were examined under 3 to 40× magnification. Results: The petrosal branch of the middle meningeal artery is the sole source of supply that crossed the floor of the middle fossa to irrigate the facial nerve. The petrosal artery usually arises from the first 10-mm segment of the middle meningeal artery after it passes through the foramen spinosum, but it can arise within or just below the foramen spinosum. The petrosal artery is commonly partially or completely hidden in the bone below the middle fossa floor. It most commonly reaches the facial nerve by passing through the bone enclosing the geniculate ganglion and tympanic segment of the nerve and less commonly by passing through the hiatus of the greater petrosal nerve. The petrosal artery frequently gives rise to a branch to the trigeminal nerve. The middle meningeal artery was absent in one of the 25 middle fossae, and a petrosal artery could not be identified in four middle fossae. The petrosal arteries were divided into three types based on their pattern of supply to the facial nerve. Conclusion: The petrosal artery is at risk of being damaged during procedures in which the dura is elevated from the floor of the middle fossa, the middle fossa floor is drilled, or the middle meningeal artery is embolized or sacrificed. Several recommendations are offered to avoid damaging the facial nerve supply while performing such interventions.

Posterior cervical spinal cord infarction complicating the treatment of an intracranial dural arteriovenous fistula embolization

2006 ◽  
Vol 5 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Raphaël Blanc ◽  
Hassan Hosseini ◽  
Caroline Le Guerinel ◽  
Pierre Brugières ◽  
André Gaston
Keyword(s):  
Cervical Spinal Cord ◽  
Rare Complication ◽  
Arterial Embolization ◽  
Middle Meningeal Artery ◽  
Embolic Agent ◽  
Spinal Cord Infarction ◽  
Computed Tomography Scanning ◽  
Upper Cervical ◽  
Posterior Meningeal Artery ◽  
Meningeal Artery

✓ Acute ischemic infarction of the posterolateral bulbomedullary junction occurred in a 28-year-old man who underwent arterial embolization for the treatment of an intracranial dural arteriovenous malformation. The migration of the embolic agent in the posterior spinal artery via a peripheral anastomosis between the middle meningeal artery and the posterior meningeal artery was responsible for this complication. The cast of glue in the radiculopial system at the upper cervical level was visible on computed tomography scanning, and magnetic resonance imaging demonstrated circumscribed signal changes and restricted diffusion in the arterial territory of the bulbomedullary junction. The authors discuss the anatomical, clinical, and technical issues of this rare complication.

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