Facial Nerve Function Recovery after Removal of Cerebellopontine Angle Tumor

Abstract BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor surgery. Several donor nerves have been used in the past for facial reanimation. We report the results of 30 cases of masseter-to-facial anastomosis. OBJECTIVE To prospectively evaluate the efficacy of V to VII anastomosis after FP. METHODS In a prospective study, we included 30 consecutive patients with FP (20 women and 10 men) whose mean age was 48.8 yr (32-76 yr). In almost all cases, FP developed after cerebellopontine angle tumor surgery (29 patients), whereas in one case, FP occurred after skull base trauma. Pre- and postoperative evaluation of facial nerve function was performed using the House-Brackmann (HB) scale and the Sokolovsky scale, as well as by electromyography. Follow-up ranged from 11 to 51 mo and averaged 22 mo. RESULTS All patients achieved functional recovery of the facial nerve from VI to either III or IV HB degree. Patients with short time FP showed significantly better postoperative recovery. CONCLUSION The results of the V to VII anastomosis demonstrate a significant improvement of facial nerve function and virtually no complications.

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Surgical Outcomes of Cerebellopontine Angle Tumors in 34 Cases

Pulse ◽

10.3329/pulse.v8i1.28095 ◽

2016 ◽

Vol 8 (1) ◽

pp. 8-14 ◽

Cited By ~ 1

Author(s):

Md Aliuzzaman Joarder ◽

AKM Bazlul Karim ◽

Shariful Islam Sujon ◽

Nahid Akhter ◽

Md Waheeduzzaman ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Cerebellopontine Angle ◽

Csf Leak ◽

Radical Excision ◽

Nerve Function ◽

Facial Nerve Function ◽

Lower Cranial Nerve ◽

Cerebellopontine Angle Tumor ◽

Cerebellopontine Angle Tumors

Introduction: Cerebellopontine angle tumors are a surgical challenge to many neurosurgeons who want to operate in this space. Although most of these tumors are benign, they are a challenge because of the complex anatomy and important neurovascular structures that traverse this space. Most common cerebellopontine angle tumor is vestibular schwannoma. The management of these cases is essentially surgical. There has been a change in the surgical strategy over the years from simple intratumoral decompression to complete microsurgical excision, to radical excision with facial nerve and hearing preservation.Objectives: To study the clinical and radiological characteristics, know the pathological types and determine the surgical resectability and outcome of cerebellopontine angle tumor.Materials and Methods: It is a retrospective study done in the department of Neurosurgery, Apollo Hospitals Dhaka. 34 patients diagnosed with cerebellopontine angle tumor were recruited into the study.Results: Among 34 cases of cerebellopontine angle tumors vestibular schwannoma alone constituted 79%. Most of the tumors were large or giant tumors. Total resection was done in 25% of vestibular schwannoma and 50% of meningiomas. Anatomical preservation of facial nerve was achieved in 73% of patients. Facial nerve function as measured by the House Brackmann system. Postoperatively 61% had a score of 1 or 2; 29% had a score of 3 or 4; and 8% had a score of 5 or 6. Other complications included 2 cases of CSF leak, 3 cases of meningitis, 2 cases of lower cranial nerve palsy and 1 patient died.Conclusion: Cerebellopontine angle tumors show high incidence from 3rd to 5th decade with common symptoms being hearing loss and ataxia. Most of the patients presented at a delayed stage with large to giant tumors with no useful hearing. Sub total excision with keeping anterior part of tumor for preserving facial nerve function is the goal.Pulse Vol.8 January-December 2015 p.8-14

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Intraoperative transcranial facial motor evoked potential monitoring in surgery of cerebellopontine angle tumors predicts early and late postoperative facial nerve function

Clinical Neurophysiology ◽

10.1016/j.clinph.2020.12.025 ◽

2021 ◽

Vol 132 (4) ◽

pp. 864-871

Author(s):

Ryo Hiruta ◽

Taku Sato ◽

Takeshi Itakura ◽

Masazumi Fujii ◽

Jun Sakuma ◽

...

Keyword(s):

Facial Nerve ◽

Cerebellopontine Angle ◽

Evoked Potential ◽

Motor Evoked Potential ◽

Nerve Function ◽

Facial Nerve Function ◽

Cerebellopontine Angle Tumors ◽

Evoked Potential Monitoring ◽

Potential Monitoring

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Resection of a Dumbbell-Shaped Facial Nerve Schwannoma With Preservation of Facial Nerve Function Through the Extended Middle Fossa Approach: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab335 ◽

2021 ◽

Author(s):

Kaith K Almefty ◽

Wenya Linda Bi ◽

Walid Ibn Essayed ◽

Ossama Al-Mefty

Keyword(s):

Facial Nerve ◽

Cerebellopontine Angle ◽

Internal Auditory Canal ◽

Growth Patterns ◽

Geniculate Ganglion ◽

Nerve Function ◽

Middle Fossa ◽

Facial Nerve Function ◽

Large Tumor ◽

Middle Fossa Approach

Abstract Facial nerve schwannomas are rare and can arise from any segment along the course of the facial nerve.1 Their location and growth patterns present as distinct groups that warrant specific surgical management and approaches.2 The management challenge arises when the facial nerve maintains good function (House-Brackmann grade I-II).3 Hence, a prime goal of management is to maintain good facial animation. In large tumors, however, resection with facial nerve function preservation should be sought and is achievable.4,5 While tumors originating from the geniculate ganglion grow extradural on the floor of the middle fossa, they may extend via an isthmus through the internal auditory canal to the cerebellopontine angle forming a dumbbell-shaped tumor. Despite the large size, they may present with good facial nerve function. These tumors may be resected through an extended middle fossa approach with preservation of facial and vestibulocochlear nerve function. The patient is a 62-yr-old man who presented with mixed sensorineural and conductive hearing loss and normal facial nerve function. Magnetic resonance imaging (MRI) revealed a large tumor involving the middle fossa, internal auditory meatus, and cerebellopontine angle. The tumor was resected through an extended middle fossa approach with a zygomatic osteotomy and anterior petrosectomy.6 A small residual was left at the geniculate ganglion to preserve facial function. The patient did well with hearing preservation and intact facial nerve function. He consented to the procedure and publication of images. Image at 1:30 © Ossama Al-Mefty, used with permission. Images at 2:03 reprinted from Kadri and Al-Mefty,6 with permission from JNSPG.

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Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas

Otolaryngology ◽

10.1016/s0194-5998(95)70241-5 ◽

1995 ◽

Vol 112 (2) ◽

pp. 228-234 ◽

Cited By ~ 35

Author(s):

B SCHALLER ◽

R HEILBRONNER ◽

C PFALTZ ◽

R PROBST ◽

O GRATZL

Keyword(s):

Facial Nerve ◽

Cerebellopontine Angle ◽

Nerve Function ◽

Facial Nerve Function

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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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