scholarly journals Translabyrinthine Approach for Resection of Large Cystic Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S267-S268
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Extracapsular Dissection ◽  
Cerebellar Retraction

The translabyrinthine approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a translabyrinthine approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the translabyrinthine approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function.The link to the video can be found at: https://youtu.be/zld2cSP8fb8.

scholarly journals Retrosigmoid Transmeatal Approach for Resection of Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S269-S270
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Protective Layer ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Nerve Preservation ◽  
Tumor Capsule ◽  
Acoustic Neuromas ◽  
Dissection Technique

The retrosigmoid (suboccipital) approach is the workhorse for most acoustic neuromas in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate the nuances of the subperineural dissection technique for microsurgical resection of an acoustic neuroma via the retrosigmoid transmeatal approach. The plane is developed by separating the perineurium of the vestibular nerve away from the tumor capsule. This perineurium provides a protective layer between the tumor capsule and the facial nerve which serves as a buffer to avoid direct dissection and potential trauma to the facial nerve. Using this technique during extracapsular tumor dissection helps to maximize the extent of tumor removal while preserving facial nerve function. A gross total resection of the tumor was achieved, and the patient exhibited normal facial nerve function (Fig. 1). In summary, the retrosigmoid transmeatal approach with the use of subperineural dissection are important strategies in the armamentarium for surgical management of acoustic neuromas with the goal of maximizing tumor removal and preserving facial nerve function (Fig. 2).The link to the video can be found at: https://youtu.be/L3lPtSvJt60.

Observer variations in the evaluation of facial nerve function after acoustic neuroma surgery

1993 ◽  
Vol 107 (12) ◽  
pp. 1119-1121 ◽  
Author(s):  
Christian Buchwald ◽  
Mirko Tos ◽  
Jens Thomsen ◽  
Henrik MØller ◽  
Agnete Parving
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Function ◽  
Surgical Team ◽  
Facial Nerve Function ◽  
Face To Face ◽  
Translabyrinthine Approach ◽  
Acoustic Neuroma Surgery ◽  
Grading Scale

This investigation was performed in order to evaluate the observer variations in facial nerve function after surgery for an acoustic neuroma. From 1976–90, 507 patients were operated on by the same surgical team (M.T. and J.T.) using a translabyrinthine approach. One hundred and forty-four patients living in Copenhagen City and County were invited for interview and objective examination. Only 128 patients attended the interview and examination which were carried out by the same ENT physician. Data concerning observation of the facial nerve function only is presented. Its function was clinically evaluated (using the House and Brackmann (1985) grading scale) by two different observers i.e the ENT physician and one of the surgeons. The patients were asked face-to-face with the ENT physician to estimate the degree of facial nerve function according to a 0–100 per cent scale. Comparing normal and abolished facial nerve function the judgments of the ENT physician and the surgeon agreed with the patient‘s own evaluation.

Translabyrinthine resection of small intracanalicular acoustic tumor

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Ioannis Karampelas ◽  
Cameron Wick ◽  
Maroun Semaan ◽  
Cliff A. Megerian ◽  
Nicholas C. Bambakidis
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Progressive Increase ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
The Past ◽  
Link Type ◽  
Translabyrinthine Approach ◽  
Acoustic Tumor

This case is an example of a translabyrinthine resection of a small intracanalicular acoustic tumor. The patient is a 69-year-old right-handed woman with complaints of progressive incapacitating vertigo and right-sided hearing loss worsening over the past 3 years. She had normal facial nerve function with imaging demonstrating progressive increase in size of a small right-sided acoustic tumor. A translabyrinthine approach was performed, and the mass was resected completely. Facial nerve function remained normal immediately after surgery.The video can be found here: http://youtu.be/27ARlLLSbKE.

scholarly journals Retractorless translabyrinthine approach for resection of a large acoustic neuroma: operative video and technical nuances

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu ◽  
Robert W. Jyung
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Tumor Resection ◽  
Fat Graft ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Large acoustic neuromas, greater than 3 cm, can be technically challenging tumors to remove because of their intimate relationship with the brainstem and surrounding cranial nerves. Successful tumor resection involves functional preservation of the facial nerve and neurovascular structures. The translabyrinthine approach is useful for surgical resection of acoustic neuromas of various sizes in patients with poor preoperative hearing. The presigmoid surgical corridor allows direct exposure of the tumor in the cerebellopontine angle without any fixed cerebellar retraction. Early identification of the facial nerve at the fundus facilitates facial nerve preservation. Large acoustic tumors can be readily removed with a retractorless translabyrinthine approach using dynamic mobilization of the sigmoid sinus. In this operative video atlas report, the authors demonstrate their operative nuances for resection of a large acoustic neuroma via a translabyrinthine approach using a retractorless technique. Facial nerve preservation is achieved by maintaining a plane of dissection between the tumor capsule and the tumor arachnoid so that a layer of arachnoid protects the blood supply to the facial nerve. Multilayered closure is achieved with a fascial sling technique in which an autologous fascia lata graft is sutured to the dural defect to suspend the fat graft in the mastoidectomy defect. We describe the step-by-step technique and illustrate the operative nuances and surgical pearls to safely and efficiently perform the retractorless translabyrinthine approach, tumor resection, facial nerve preservation, and multi-layered reconstruction of the skull base dural defect to prevent postoperative cerebrospinal fluid leakage.The video can be found here: http://youtu.be/ros98UxqVMw.

Facial Nerve Dissection by use of Acoustic (Loudspeaker) Facial EMG Monitoring

1986 ◽  
Vol 95 (4) ◽  
pp. 458-463 ◽  
Author(s):  
Sam E. Kinney ◽  
Richard Prass
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Internal Auditory Canal ◽  
Subsequent Development ◽  
Lateral Approach ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Facial Emg ◽  
Acoustic Neuroma Surgery ◽  
Total Tumor Removal

The development of the surgical microscope in 1953, and the subsequent development of microsurgical instrumentation, signaled the beginning of modern-day acoustic neuroma surgery. Preservation of facial nerve function and total tumor removal is the goal of all acoustic neuroma surgery. The refinement of the translabyrinthine removal of acoustic neuromas by Dr. William House’ significantly improved preservation of facial nerve function. This is made possible by the anatomic identification of the facial nerve at the lateral end of the internal auditory canal. When the surgery is accomplished from a suboccipital or retrosigmoid approach, the facial nerve may be identified at the brain stem or within the internal auditory canal. Identifying the facial nerve from the posterior approach is not as anatomically precise as from the lateral approach through the labyrinth. The use of a facial nerve stimulator can greatly facilitate Identification of the facial nerve in these procedures.

scholarly journals The Offprint of an Abnormal Pre-Parotidectomy Electrodiagnostic Finding in a Normally Functioning Facial Nerve: Correlation with Intraoperative Findings, Histology and Postoperative Facial Nerve Function

2022 ◽  
Vol 11 (1) ◽  
pp. 248
Author(s):  
Verena Katheder ◽  
Matti Sievert ◽  
Sarina Katrin Müller ◽  
Vivian Thimsen ◽  
Antoniu-Oreste Gostian ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Malignant Tumor ◽  
Facial Palsy ◽  
Benign Lesion ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Clinically Normal ◽  
Parotid Tumors ◽  
Supramaximal Stimulation

The aim of this study was to search for associations between an electrodiagnostically abnormal but clinically normal facial nerve before parotidectomy and the intraoperative findings, as well as the postoperative facial nerve function. The records of all patients treated for parotid tumors between 2002 and 2021 with a preoperative House–Brackmann score of grade I but an abnormal electrophysiologic finding were studied retrospectively. A total of 285 patients were included in this study, and 222 patients had a benign lesion (77.9%), whereas 63 cases had a malignant tumor (22.1%). Electroneurographic facial nerve involvement was associated with nerve displacement in 185 cases (64.9%) and infiltration in 17 cases (6%). In 83 cases (29.1%), no tumor–nerve interface could be detected intraoperatively. An electroneurographic signal was absent despite supramaximal stimulation in 6/17 cases with nerve infiltration and in 17/268 cases without nerve infiltration (p < 0.001). The electrophysiologic involvement of a normal facial nerve is not pathognomonic for a malignancy (22%), but it presents a rather rare (~6%) sign of a “true” nerve infiltration and could also appear in tumors without any contact with the facial nerve (~29%). Of our cases, two thirds of those with an anatomic nerve preservation and facial palsy had already directly and postoperatively recovered to a major extent in the midterm.

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