Results of Hypoglossal-facial Nerve Anastomosis for Facial Palsy Following Acoustic Neuroma Excision

AbstractThis evaluation of recent experience of hypoglossal-facial nerve anastomosis in ten patients who had undergone acoustic neuroma resection, indicates that this procedure may have a role to play in the treatment of this disfiguring condition. Facial symmetry at rest is satisfactory in the majority of patients, who suffered little long term deficit from the loss of their hypoglossal nerve. This procedure is ideally suited to otolaryngological practice.

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One-stage Removal of Residual Intracanalicular Acoustic Neuroma and Hemihypoglossal-intratemporal Facial Nerve Anastomosis: Technical Note

Neurosurgery ◽

10.1227/01.neu.0000093830.14935.39 ◽

2003 ◽

Vol 53 (6) ◽

pp. 1444-1448 ◽

Cited By ~ 16

Author(s):

Renato Donzelli ◽

Gaetano Motta ◽

Luigi Maria Cavallo ◽

Francesco Maiuri ◽

Enrico de Divitiis

Keyword(s):

Facial Nerve ◽

Acoustic Neuroma ◽

Facial Palsy ◽

Residual Tumor ◽

Surgical Removal ◽

Translabyrinthine Approach ◽

One Stage ◽

Incomplete Removal ◽

Nerve Anastomosis ◽

Suboccipital Approach

Abstract OBJECTIVE AND IMPORTANCE Incomplete removal of residual intracanalicular tumor and injury to the facial nerve are the main problems associated with surgery of large acoustic neuromas via the retromastoid suboccipital approach. In patients with residual or recurrent intracanalicular neuromas, the translabyrinthine approach is the preferred surgical route, allowing complete tumor removal; it may eventually also be used for exposure of the intratemporal portion of the facial nerve for a hemihypoglossal-facial nerve anastomosis when a postoperative facial palsy exists This one-stage procedure has not been described previously. CLINICAL PRESENTATION Three patients with postoperative facial palsy and residual intracanalicular tumor after surgical removal of a large acoustic neuroma via the retromastoid suboccipital approach underwent reoperation via the translabyrinthine approach and one-stage removal of the residual tumor and hemihypoglossal-facial nerve anastomosis. All three patients had a complete facial palsy of House-Brackmann Grade VI and a residual tumor of 8 to 12 mm. TECHNIQUE A classic translabyrinthine approach was used to open the internal auditory canal and remove the residual intracanalicular tumor. The facial nerve was exposed in its mastoid and tympanic parts, mobilized, and transected; then, the long nerve stump was transposed into the neck and used for an end-to-side anastomosis into the hypoglossal nerve. The operation resulted in variable improvement of the facial muscle function up to Grade III (one patient) and Grade IV (two patients). CONCLUSION Reoperation via the translabyrinthine approach is indicated for removal of residual intracanalicular acoustic neuroma and realization of a hypoglossal-facial nerve anastomosis in a single procedure. It is suggested that this type of anastomosis may also be used during the initial operation for acoustic neuroma removal when the facial nerve is inadvertently sectioned.

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Causes of Facial Nerve Paresis after Translabyrinthine Surgery for Acoustic Neuroma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210101004 ◽

1992 ◽

Vol 101 (10) ◽

pp. 821-826 ◽

Cited By ~ 18

Author(s):

Mirko Tos ◽

Jens Thomsen ◽

Mahmoud Youssef ◽

Suat Turgut

Keyword(s):

Facial Nerve ◽

Brain Stem ◽

Acoustic Neuroma ◽

Facial Palsy ◽

Cerebellopontine Angle ◽

Patient Records ◽

Nerve Function ◽

Facial Nerve Function ◽

Common Site ◽

Nerve Paresis

Forty-six consecutive video-recorded translabyrinthine operations at Gentofte Hospital, for tumors of 5 to 25 mm, were investigated for possible damage to the facial nerve from cauterization, suction, stretching, pushing, and other instrumental trauma at the following regions: fundus, internal meatus, porus, cerebellopontine angle, and brain stem. House-Brackmann grading of the postoperative facial nerve function was determined from the patient records for the 1st, 3rd, and 10th days and 3 months and 6 months postoperatively, as well as the final status. Suction on the nerve seems to be the most important factor for perioperative facial nerve damage. The most common site of damage was the porus region. This investigation shows thermic drilling lesions to be very relevant. There was no correlation between the degree and character of damage and the postoperative facial nerve function. In eight patients we cannot explain the postoperative facial palsy.

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Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors

Journal of Neurosurgery ◽

10.3171/jns.1992.77.5.0724 ◽

1992 ◽

Vol 77 (5) ◽

pp. 724-731 ◽

Cited By ~ 58

Author(s):

Luis F. Pitty ◽

Charles H. Tator

Keyword(s):

Facial Nerve ◽

Facial Palsy ◽

Cerebellopontine Angle ◽

Surgical Techniques ◽

Content Type ◽

Factors Affecting ◽

Cerebellopontine Angle Tumors ◽

Nerve Anastomosis ◽

Fair Poor ◽

Fine Print

✓ Hypoglossal-facial nerve anastomosis is one of the procedures frequently performed to restore function after facial palsy secondary to surgery for removal of cerebellopontine angle tumors. The published results of hypoglossal-facial nerve anastomosis have been variable, and there are still questions about the indications, timing, and surgical techniques for this procedure. The goals of the present retrospective analysis of 22 cases of hypoglossal-facial nerve anastomosis were to assess the extent of the functional recovery and to analyze the factors affecting this recovery. The 22 cases of complete facial palsy were gleaned from a series of 245 cases of cerebellopontine angle tumors treated surgically by one of the authors. Twenty patients had an acoustic neuroma (average size 3.5 cm), one patient had a petrous meningioma, and one patient had a facial neuroma. The average age of the patients was 47.3 years (range 19 to 69 years). The average interval from tumor surgery to hypoglossal-facial nerve anastomosis was 6.4 months (range 12 days to 17 months), and the average follow-up period after the procedure was 65 months. The results were graded as good, fair, poor, or failure according to a new method of classifying facial nerve function after hypoglossal-facial nerve anastomosis. The results were good in 14 cases (63.6%), fair in three (13.6%), and poor in four (18.2%); one (4.5%) was a failure. Good and fair results occurred with higher frequency in younger patients who were operated on within shorter intervals, although these relationships were not statistically significant. There were no surgical complications. Good or fair results were achieved in 17 (77.3%) of the 22 cases, and thus hypoglossal-facial nerve anastomosis is considered an effective procedure for most patients with facial palsy after surgery for cerebellopontine angle tumors.

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Combination of hypoglossal-facial nerve surgical reconstruction and neurotrophin-3 gene therapy for facial palsy

Journal of Neurosurgery ◽

10.3171/2013.1.jns121176 ◽

2013 ◽

Vol 119 (3) ◽

pp. 739-750 ◽

Cited By ~ 9

Author(s):

Hong Wan ◽

Liwei Zhang ◽

Stephane Blanchard ◽

Stephanie Bigou ◽

Delphine Bohl ◽

...

Keyword(s):

Gene Therapy ◽

Facial Nerve ◽

Nerve Injury ◽

Facial Palsy ◽

Surgical Reconstruction ◽

Hypoglossal Motoneurons ◽

Facial Nerve Injury ◽

Neurotrophin 3 ◽

Whisker Pad ◽

Nerve Anastomosis

Object Facial nerve injury results in facial palsy that has great impact on the psychosocial conditions of affected patients. Reconstruction of the facial nerve to restore facial symmetry and expression is still a significant surgical challenge. In this study, the authors assessed a hypoglossal-facial nerve anastomosis method combined with neurotrophic factor gene therapy to treat facial palsy in adult rats after facial nerve injury. Methods Surgery consisted of the interposition of a predegenerated nerve graft (PNG) that was anastomosed with the hypoglossal and facial nerves at each of its extremities. The hypoglossal nerve was cut approximately 50% for this anastomosis to conserve partial hypoglossal function. Before their transplantation, the PNGs were genetically engineered using lentiviral vectors to induce overexpression of the neurotrophic factor neurotrophin-3 (NT-3) to improve axonal regrowth in the reconstructed nerve pathway. Reconstruction was performed after facial nerve injury, either immediately or after a delay of 9 weeks. The rats were followed up for 4 months postoperatively, and treatment outcomes were then assessed. Results Compared with the functional innervation in control rats that underwent facial nerve injury without subsequent treatment, functional innervation of the paralyzed whisker pad by hypoglossal motoneurons in rats treated 4 months after nerve reconstruction was evidenced by the retrograde transport of neuronal tracers, the recording of muscle action potentials conducted by the PNG, and the recovery of facial symmetry. Although a better outcome was observed when reconstruction was performed immediately after facial nerve injury, reconstruction with NT3-treated PNGs significantly improved functional reinnervation of the paralyzed whisker pad even when implantation occurred 9 weeks posttrauma. Conclusions Results demonstrated that hypoglossal-facial nerve anastomosis facilitates innervation of paralyzed facial muscle via hypoglossal motoneurons without sacrificing ipsilateral hemitongue function. Neurotrophin-3 treatment through gene therapy could effectively improve such innervation, even after delayed reconstruction. These findings suggest that the combination of surgical reconstruction and NT-3 gene therapy is promising for its potential application in treating facial palsy in humans.

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Hypoglossal-Facial Nerve Anastomosis after Acoustic Neuroma Resection: Influence of the Time of Anastomosis on Recovery of Facial Movement

ORL ◽

10.1159/000276791 ◽

1996 ◽

Vol 58 (1) ◽

pp. 32-35 ◽

Cited By ~ 19

Author(s):

T. Kunihiro ◽

J. Kanzaki ◽

S. Yoshihara ◽

Y. Satoh ◽

A. Satoh

Keyword(s):

Facial Nerve ◽

Acoustic Neuroma ◽

Facial Movement ◽

Nerve Anastomosis

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Viral Titers and Delayed Facial Palsy after Acoustic Neuroma Surgery

Otolaryngology ◽

10.1067/mhn.2002.129817 ◽

2002 ◽

Vol 127 (5) ◽

pp. 427-431 ◽

Cited By ~ 25

Author(s):

Gerard J. Gianoli

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Facial Nerve ◽

Acoustic Neuroma ◽

Facial Palsy ◽

Nerve Function ◽

Facial Nerve Function ◽

Acoustic Neuroma Surgery ◽

Simplex Virus ◽

Viral Titers

OBJECTIVE: Delayed facial palsy (DFP) after acoustic neuroma surgery has been reported to occur in up to one third of cases. Reactivation of latent virus has been proposed as an etiology for DFP. However, only retrospective case reports and case series have offered data to support this theory. The objective of this study was to correlate DFP with change in viral titers. PATIENTS AND METHODS: Twenty consecutive patients who underwent acoustic neuroma surgery were prospectively evaluated for viral titers immediately preoperatively and at 3 weeks postoperatively. Viral titers measured included herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), and varicella zoster virus (VZV) and included both IgG and IgM titers. The status of facial nerve function was documented preoperatively and throughout the postoperative period. Patients were categorized according to the presence or absence of DFP. RESULTS: Seven patients developed DFP after acoustic neuroma surgery, while the remaining 13 patients did not. There was no difference in preoperative and 3-week postoperative IgG titers for any of the 3 viruses tested. However, IgM titers were much higher postoperatively in DFP patients for all 3 viruses tested. The average HSV-1 IgM titer rose 92% in DFP patients compared with only 4.5% in the patients who did not develop DFP. Average HSV-2 IgM titers rose 70% compared with a decline of 8.5% in non-DFP patients. Most strikingly, VZV IgM titers rose an average 495% postoperatively among DFP patients compared with a decline of 14% in the non-DFP patients. CONCLUSION: Elevation of the IgM titers of the viruses measured in this study implies that recrudescence of the virus has occurred. The absence of this rise among patients who did not develop DFP implies that viral recrudescence plays a role in the etiology of DFP. These findings support treatment or prophylaxis of DFP with antiviral therapy. Although the finding of normal facial nerve function immediately after acoustic neuroma surgery is an excellent prognostic indicator for the ultimate outcome of facial nerve function, it is not uncommon for the patient to exhibit deterioration of facial nerve function in the first few days to weeks after surgery. When facial palsy is not complete, the prognosis remains excellent. However, when there is total loss of facial nerve function, the final outcome is more variable. Delayed facial palsy (DFP) after acoustic neuroma surgery has been defined as initially normal facial nerve function noted immediately postoperative with subsequent deterioration of facial nerve function. 1 This phenomenon has been noted to occur in up to one third of cases. Numerous causes for this entity have been proposed, including neural devascularization, vasospasm, edema, immune reactions, and viral reactivation. Varicella zoster virus (VZV) and herpes simplex virus (HSV) are ubiquitous, with more than 90% of the adult population demonstrating evidence of prior infection. 2 Reactivation of latent VZV has been implicated as the cause of Ramsay Hunt syndrome. 3 There is mounting evidence that HSV reactivation is the cause of Bell's palsy. 4 In the present study, viral titers for VZV and HSV were assessed before and after acoustic neuroma surgery. DFP and non-DFP patients were compared in an attempt to determine whether there was any correlation between viral recrudescence and DFP.

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Hemihypoglossal—facial nerve anastomosis in treating unilateral facial palsy after acoustic neurinoma resection

Journal of Neurosurgery ◽

10.3171/jns.1995.82.1.0051 ◽

1995 ◽

Vol 82 (1) ◽

pp. 51-54 ◽

Cited By ~ 76

Author(s):

Hajime Arai ◽

Kiyoshi Sato ◽

Akira Yanai

Keyword(s):

Facial Nerve ◽

Facial Palsy ◽

Hypoglossal Nerve ◽

Tumor Resection ◽

Postoperative Recovery ◽

Acoustic Neurinoma ◽

Content Type ◽

Facial Reanimation ◽

Nerve Anastomosis

✓ Eight patients underwent hemihypoglossal—facial nerve anastomosis (anastomosis of a split hypoglossal nerve to the facial nerve) for treatment of unilateral facial palsy. All patients previously had undergone resection of a large acoustic neurinoma and the facial nerve had been resected at that time. The interval between tumor resection and hemihypoglossal—facial nerve anastomosis ranged from 1 to 6 months, with an average of 2.1 months. Postoperative recovery of facial movement was good in all cases during an average follow-up period of 4.2 years. In all eight patients, the degree of hypoglossal nerve atrophy on the operated side was graded mild or moderate, but not severe. It was concluded that hemihypoglossal—facial nerve anastomosis results in good facial reanimation as long as the procedure is performed early after the onset of facial palsy and that this procedure may reduce the degree of hemiglossal atrophy in comparison with classic hypoglossal—facial nerve anastomosis.

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