Facial Nerve Outcome after Vestibular Schwannoma Resection: A Comparative Meta-Analysis of Endoscopic versus Open Retrosigmoid Approach

Background and Study Aim Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases. Methods and Results We are presenting two cases of VS with significant facial weakness. The first case was a 63-year-old male patient presented with 3 weeks' history of severe left-sided facial weakness (House–Brackmann [HB] grade V) and hearing loss. Magnetic resonance imaging (MRI) of the brain showed a tumor in the left internal auditory canal. Gross total removal with anatomical and physiological FN preservation was performed through a retrosigmoid approach under neurophysiological monitoring. FN function improved postoperatively to HB grade II after 16 months. The other case was 83-year-old male patient presented with sudden left-sided hearing loss and severe facial weakness (HB grade V). MRI of the brain 2.5 years before showed a left-sided (Class-T3A) cystic VS. The tumor was asymptomatic; wait-and-scan strategy was advised by the treating neurologist. Recent MRI of the brain showed approximately three times enlargement of the tumor with brain stem compression, extensive cystic changes, and suspected intratumoral hemorrhage. Surgery was performed; the tumor was subtotally removed through a retrosigmoid approach with intraoperative FN monitoring. The FN was anatomically preserved; however, physiological preservation was not possible. Severe facial weakness with incomplete lid closure persisted postoperatively. Conclusion Surgical treatment could be offered to cases of suspected VS presenting with facial weakness, as these cases may still have a chance for improvement especially in laterally located tumors.

Download Full-text

Post - Operative Facial Nerve Preservation after Vestibular Schwannoma (vs) Resection: A Comparative Meta-Analysis of Endoscopic vs. Open Resection Surgery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1370541 ◽

2014 ◽

Vol 75 (S 01) ◽

Author(s):

Abdullah Alobaid ◽

Mohammad Aref ◽

Michael Bennardo ◽

Forough Farrokhyar ◽

Kesh Reddy

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Meta Analysis ◽

Open Resection ◽

Nerve Preservation ◽

Facial Nerve Preservation

Download Full-text

Retrosigmoid approach for giant cystic vestibular schwannoma: subperineural dissection technique for facial nerve preservation

Neurosurgical Focus: Video ◽

10.3171/2021.7.focvid21128 ◽

2021 ◽

Vol 5 (2) ◽

pp. V7

Author(s):

Ali Tayebi Meybodi ◽

Robert W. Jyung ◽

James K. Liu

Keyword(s):

Facial Nerve ◽

Thin Layer ◽

Vestibular Schwannoma ◽

Cranial Nerve ◽

Retrosigmoid Approach ◽

Nerve Function ◽

Facial Nerve Function ◽

Total Resection ◽

Nerve Preservation ◽

Dissection Technique

In this illustrative video, the authors demonstrate retrosigmoid resection of a giant cystic vestibular schwannoma using the subperineural dissection technique to preserve facial nerve function. This thin layer of perineurium arising from the vestibular nerves is used as a protective buffer to shield the facial and cochlear nerves from direct microdissection trauma. A near-total resection was achieved, and the patient had an immediate postoperative House-Brackmann grade I facial nerve function. The operative nuances and pearls of technique for safe cranial nerve and brainstem dissection, as well as the intraoperative decision and technique to leave the least amount of residual adherent tumor, are demonstrated. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21128

Download Full-text

Facial Nerve Preservation and Surgical Outcomes of Retrosigmoid Approach to Large Vestibular Schwannoma- an Eight-year Single Institution Experience

Nepal Journal of Neuroscience ◽

10.3126/njn.v14i3.20522 ◽

2017 ◽

Vol 14 (3) ◽

pp. 19-25

Author(s):

Pratyush Shrestha ◽

Nisha Kutu ◽

Subash Lohani ◽

Upendra Prasad Devkota

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Tumor Size ◽

Statistical Significance ◽

Retrosigmoid Approach ◽

Vestibular Schwannomas ◽

P Value ◽

Exact Test ◽

Nerve Preservation ◽

Ventriculoperitoneal Shunting

Objective: To evaluate the result of microsurgical excision of vestibular schwannoma by retrosigmoid approach and to correlate the facial nerve outcome with the tumor size.Methods: Retrospective analysis of 84 patients with cerebello-pontine angle lesions (57 vestibular schwannomas) operated at National Institute of Neurological and Allied Sciences, Nepal, from Baisakh 2066 to Chaitra 2073 (eight years). Facial nerve outcomes as per the House and Brackmann grading at six months follow-up were recorded and correlated with tumor size.Result: The mean tumor size was 4.32 ± 1.23 cms and 48 (84.2%) of the patients had tumor size more than 3 cms. Patients presented late with papilloedema documented in 42.1% and preoperative ventriculoperitoneal shunting required in 31.57% patients. Of the patients whose facial nerve functions could be followed up, all patients with tumors < 3cm diameter had good House and Brackmann facial nerve outcome (grade I to III). Larger tumors had poorer facial nerve outcomes; however statistical significance could not be reached. (Fischer Exact test, p-value: 0.077). There were two mortalities (3.5%), one following cavity rebleed and one following malignant brain swelling.Conclusion: Retrosigmoid approach is a versatile surgical corridor to excise large vestibular schwannomas with minimal complications and larger tumors have poorer facial nerve outcomes. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, Page: 19-25

Download Full-text