scholarly journals Chances of Improvement in Cases of Vestibular Schwannoma Presenting with Facial Nerve Weakness: Presentation of Two Cases and Literature Review

2018 ◽  
Vol 80 (01) ◽  
pp. 040-045
Author(s):  
Ahmed Rizk ◽  
Marcus Mehlitz ◽  
Martin Bettag
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Male Patient ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Neurophysiological Monitoring ◽  
Facial Weakness ◽  
First Case ◽  
The Brain

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.

scholarly journals Unilateral internal auditory canal stenosis with progressive facial weakness

2012 ◽  
Vol 18 (2) ◽  
pp. 179-182
Author(s):  
Sathiya Murali ◽  
Arpana Shekhar ◽  
S Shyam Sudhakar ◽  
Kiran Natarajan ◽  
Mohan Kameswaran
Keyword(s):  
Hearing Loss ◽  
High Resolution ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Internal Auditory Canal ◽  
Facial Weakness ◽  
Profound Hearing Loss ◽  
Canal Stenosis ◽  
Temporal Bone Ct ◽  
Magnetic Resonance Imaging Mri

Internal auditory canal (IAC) stenosis is a rare cause of sensorineural hearing loss. Patient may present with symptoms of progressive facial nerve palsy, hearing loss, tinnitus and giddiness. High resolution temporal bone CT-scan and magnetic resonance imaging (MRI) are the important tools for diagnosis. No specific management has been devised. Here is presentation of a case of unilateral (left) IAC stenosis with profound hearing loss and progressive House Brackmann Grade III-IV facial weakness. The diameter of the IAC was less than 2 mm on high resolution temporal bone computed tomography (HRCT) scan. It was managed by facial nerve decompression by translabyrinthine approach in an attempt to prevent further deterioration of facial palsy. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12014 Bangladesh J Otorhinolaryngol 2012; 18(2): 179-182

Suboccipital Surgical Approach to the Cerebellopontine Angle and Internal Auditory Canal

1978 ◽  
Vol 71 (4) ◽  
pp. 273-274 ◽  
Author(s):  
Mansfield F W Smith
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Prone Position ◽  
Surgical Approach ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Total Removal ◽  
Size And Shape ◽  
Suboccipital Craniectomy ◽  
The Brain

The suboccipital craniectomy done with the patient in the prone position using modern microsurgical methods gives good anatomical exposure essential for efficient, accurate, total removal of cerebellopontine angle neoplasms and allows adjacent. uninvolved neurological structures to be spared. Modifying the anatomical exposure by varying the size and shape of the osseous craniectomy and placing the dural incision closer to the porus acousticus permits extradural retraction of the cerebellum. Thus large cerebellopontine angle neoplasms can be excised with less chance of damage to the cerebellum and smaller risk of hydrocephalus. The suboccipital craniectomy may be extended anteriorly to the facial nerve, thereby combining the suboccipital with the translabyrinthine approach. and providing a more direct angle to a large neoplasm involving the brain stem and cerebellum.

Cavernous angioma of the internal auditory canal

2004 ◽  
Vol 118 (5) ◽  
pp. 368-371 ◽  
Author(s):  
Kristian Aquilina ◽  
Jagdeep S. Nanra ◽  
Francesca Brett ◽  
Rory McConn Walsh ◽  
Daniel Rawluk
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Sensorineural Hearing Loss ◽  
Internal Auditory Canal ◽  
Cavernous Angioma ◽  
Dynamic Nature ◽  
First Report ◽  
Cavernous Angiomas ◽  
Nerve Paresis

Cavernous angiomas of the internal auditory canal are rare lesions. The authors present a case of a 29-year-old lady with multiple infratentorial cavernous angiomas, whose sister had previously undergone surgery for a similar supratentorial lesion. She initially presented with an acute brainstem haematoma, secondary to a pontine cavernous angioma. Three years later she developed progressive right-sided sensorineural hearing loss and facial nerve paresis due to an internal auditory canal lesion. This was removed via the translabyrinthine approach and was found to be a cavernous angioma. This report underlines the multiple and dynamic nature of familial cavernous angiomas, as well as the importance of follow up to determine whether new symptoms are due to the enlargement of known angiomas or the development of new ones. As far as the authors are aware, this is the first report describing a cavernous angioma of the internal auditory canal in the context of familial and multiple infratentorial angiomas.

Sudden deafness in vestibular schwannoma

1994 ◽  
Vol 108 (2) ◽  
pp. 116-119 ◽  
Author(s):  
David A. Moffat ◽  
David M. Baguley ◽  
Hubertus von Blumenthal ◽  
Richard M. Irving ◽  
David G. Hardy
Keyword(s):  
Hearing Loss ◽  
Vestibular Schwannoma ◽  
Tumour Size ◽  
Internal Auditory Canal ◽  
Sudden Deafness ◽  
Aetiological Factor ◽  
Caloric Test ◽  
Significant Difference ◽  
Facial Numbness ◽  
The Mean

AbstractTwelve per cent of a series of 284 patients with vestibular schwannoma presented with sudden deafness. If sudden sensorineural hearing loss is present then it is very likely to be the main presenting symptom. The mean length of patients' history is eight months shorter in this group than in the non-sudden deafness group. Sixteen per cent of vestibular schwannoma patients without sudden deafness present with a 'dead' ear whereas 29.5 per cent of those presenting with sudden deafness have total hearing loss. There was no significant difference between the sudden deafness group and the 'all others' group with regard to tumour size, udiogram shape, caloric test, imbalance, and facial numbness. Although the numbers of patients with sudden deafness in this series were too small to reach significance, on the basis of the clinical correlation of vestibular schwannoma morphology it is possible to postulate that compression of the vasculature within the bony internal auditory canal by a laterally arising tumour may be the aetiological factor and may be more likely to occur than in more medially arising tumours.

Syphilis causing hearing loss

2008 ◽  
Vol 19 (10) ◽  
pp. 721-722 ◽  
Author(s):  
S Y Chan ◽  
M Medhi ◽  
A Ekbote ◽  
S Moses ◽  
N Sibtain ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Highly Active Antiretroviral Therapy ◽  
Internal Auditory Canal ◽  
Secondary Syphilis ◽  
Hiv Positive ◽  
Magnetic Resonance Imaging Scan ◽  
Facial Weakness ◽  
Highly Active ◽  
Syphilis Serology ◽  
Hiv 1

An HIV-positive man with hepatitis B co-infection, naïve to highly active antiretroviral therapy, with a CD4 of 594 copies/mL and HIV-1 viral load of 140,070 copies, presented with right-sided facial weakness and hearing loss. He had been treated for secondary syphilis three months earlier when his rapid plasma reagin (RPR) result was 1:16, this had fallen to neat. At presentation, his RPR had risen to 1:16 again. A magnetic resonance imaging scan showed enhancement of the internal auditory canal and right cochlea. His cerebrospinal fluid examination was normal. He was treated with acyclovir and prednisolone before the syphilis serology was known. He was then treated for syphilis with doxycycline. He made an excellent recovery.

scholarly journals Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications

2009 ◽  
Vol 27 (4) ◽  
pp. E9 ◽  
Author(s):  
A. Samy Youssef ◽  
Angela E. Downes
Keyword(s):  
Facial Nerve ◽  
Functional Outcome ◽  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Evoked Potential ◽  
Hearing Preservation ◽  
Auditory Evoked Potential ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Clinical Series

Object Intraoperative neurophysiological monitoring has become an integral part of vestibular schwannoma surgery. The aim of this article was to review the different techniques of intraoperative neurophysiological monitoring in vestibular schwannoma surgery, identify the clinical impact of certain pathognomonic patterns on postoperative outcomes of facial nerve function and hearing preservation, and highlight the role of postoperative medications in improving delayed cranial nerve dysfunction in the different reported series. Methods The authors performed a review of the literature regarding intraoperative monitoring in acoustic/vestibular schwannoma surgery. The different clinical series representing different monitoring techniques were reviewed. All the data from clinical series were analyzed in a comprehensive and comparative model. Results Intraoperative brainstem auditory evoked potential monitoring, direct cochlear nerve action potential monitoring, and facial nerve electromyography are the main tools used to assess the functional integrity of an anatomically intact cranial nerve. The identification of pathognomonic brainstem auditory evoked potential and electromyography patterns has been correlated with postoperative functional outcome. Recently, perioperative administration of intravenous hydroxyethyl starch and nimodipine as vasoactive and neuroprotective agents was shown to improve vestibular schwannoma functional outcome in few reported studies. Conclusions Recent advances in electrophysiological technology have considerably contributed to improvement in functional outcome of vestibular neuroma surgery in terms of hearing preservation and facial nerve paresis. Perioperative intravenous nimodipine and hydroxyethyl starch may be valuable additions to surgery.

Hemifacial Spasm: Treatment by Microsurgical Facial Nerve Decompression

Neurosurgery ◽  
1983 ◽  
Vol 13 (2) ◽  
pp. 141-146 ◽  
Author(s):  
John D. Loeser ◽  
James Chen
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Surgical Therapy ◽  
Hemifacial Spasm ◽  
Surgical Patients ◽  
Facial Weakness ◽  
Nerve Decompression ◽  
The Brain ◽  
Facial Nerve Decompression

Abstract The literature on hemifacial spasm and its surgical therapy is reviewed, and the authors' experiences with 20 patients are described. Vascular cross compression of the facial nerve adjacent to the brain stem is seen in 90% of the surgical patients. Mobilizing the offending vessel will cure or significantly improve approximately 80% of the patients. Complications occur in 25% of the patients and usually involve decreased hearing or facial weakness. Mortality is virtually zero, and this operation is vastly superior to any other medical or surgical therapy for hemifacial spasm. The pathophysiology is not yet understood.

Headache after Removal of Vestibular Schwannoma Via the Retrosigmoid Approach: A Long-Term Follow-Up-Study

2003 ◽  
Vol 128 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Bernhard Schaller ◽  
Ariane Baumann
Keyword(s):  
Fibrin Glue ◽  
Aseptic Meningitis ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Bone Flap ◽  
Posterior Aspect ◽  
Dural Closure ◽  
Postoperative Headache

OBJECTIVE: Our goal was to study the occurrence and source of origin of postcraniotomy headache syndrome after removal of vestibular schwannoma via the retrosigmoid approach. METHODS: A retrospective chart analysis was conducted of all patients with headache at 3 months after removal of vestibular schwannoma from January 1981 through March 1997 and with a minimum of 24 months of follow-up. Diagnosis was made according to the headache classification and was graded using the HARNER scale. Recovery outcome was compared in selected groups of patients with and without headache. A descriptive statistical analysis was used to analyze differences between groups. RESULTS: Of the patients who underwent retrosigmoid craniotomy for removal of vestibular schwannomas, 52 of 155 patients (34%) reported having severe headache of requiring medication every day and/or feeling incapacitated 3 months after surgery. Headache was more prevalent in those who had the bone flap replaced (94% versus 27%), if there was duraplastic or direct dura closure (0% versus 100%). Laboratory-proven aseptic meningitis, most likely due to the use of fibrin glue and drilling of posterior aspect of the internal auditory canal, was mainly associated with postoperative headache (81% versus 2%). In 75% of these cases, calcifications along the brainstem had been noted. CONCLUSION: The origin of postoperative headaches after retrosigmoid vestibular schwannoma resections is not yet fully understood. Different factors may play a role in preventing or reducing headache: dural adhesions to nuchal muscles or to subcutaneous tissues and dural tension in the case of direct dural closure may explain postoperative headache from dural tension. Intradural drilling and the use of fibrin glue may be the source of aseptic meningitis as the etiology of persistent postoperative headache. Prevention of postoperative headache may include the replacement of bone flap at the end of surgery, duraplastic instead of direct dural closure, and prevention of the use of fibrin glue or extensive drilling of the posterior aspect of internal auditory canal.

Cavernous haemangioma of the internal auditory canal

2000 ◽  
Vol 114 (6) ◽  
pp. 453-455 ◽  
Author(s):  
A. M. Shaida ◽  
D. J. McFerran ◽  
M. da Cruz ◽  
D. G. Hardy ◽  
D. A. Moffat
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Facial Nerve ◽  
Early Recognition ◽  
Internal Auditory Canal ◽  
Cavernous Haemangioma ◽  
Hormonal Changes ◽  
Radiological Imaging ◽  
Radiological Findings ◽  
In Pregnancy

Cavernous haemangiomas are rare lesions of the cerebello-pontine angle that can mimic the more commonly occurring vestibular schwannoma. A case report involving a patient with a cavernous haemangioma of the internal auditory canal (IAC) highlights this as a diagnostic possibility for lesions of the IAC by comparing and contrasting the clinical and radiological findings with the more commonly occurring vestibular nerve and facial schwannomas.Symptoms such as hearing loss and facial paralysis that are disproportionate to the size of the lesion or fluctuate with hormonal changes such as those seen in pregnancy are suggestive of haemangioma. Radiological imaging demonstrating a lesion enchancing with gadolinium and containing areas of calcification is also suggestive of haemangioma. It is important to consider the possible diagnosis of haemangioma as early recognition of this entity may improve the chances of preserving the functional integrity of the facial nerve.

scholarly journals Rare Occurrence of Internal Auditory Canal Stenosis Accompanied With Congenital Facial Palsy in a 3-Month-Old Infant: A Case Report

2020 ◽  
Vol 44 (3) ◽  
pp. 256-259
Author(s):  
Se-Heum Park ◽  
Woo-Jin Kim ◽  
Yun-Jung Lim ◽  
Cheol-Won On ◽  
Ji-Ho Park ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Developmental Delay ◽  
Facial Palsy ◽  
Internal Auditory Canal ◽  
Magnetic Resonance Imaging Scan ◽  
Developmental Assessment ◽  
Canal Stenosis ◽  
The Brain ◽  
Tomography Scan

Internal auditory canal (IAC) stenosis with hypoplasia of the facial and vestibulocochlear nerves is a rare cause of congenital facial palsy. In this case report, a 3-month-old female infant was referred for a neurological developmental assessment for developmental delay and congenital facial palsy. Upon evaluation of developmental delay, hearing loss was detected. Following a magnetic resonance imaging scan of the brain and a computed tomography scan of the temporal bone, IAC stenosis with hypoplasia of facial and vestibular nerves was diagnosed. This is a rare case of IAC stenosis in an infant with initial presentations of left facial palsy and developmental delay associated with hearing loss in the left ear. We strongly suggest that IAC stenosis be considered a cause of congenital facial palsy in infants, especially in patients with developmental delay. In infants with congenital facial palsy, a thorough physical examination and neurological developmental assessment should be performed.

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