Hearing Preservation and Facial Nerve Function Comparing the Middle Fossa Approach and the Retrosigmoid Approach for Removal of Vestibular Schwannomas

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
T. Lenarz ◽  
M. Tatagiba ◽  
A. Lesinski-Schiedat
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Retrosigmoid Approach ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Middle Fossa ◽  
Facial Nerve Function ◽  
Middle Fossa Approach

Hearing preservation surgery for vestibular schwannoma: experience with the middle fossa approach

2012 ◽  
Vol 33 (3) ◽  
pp. E10 ◽  
Author(s):  
Franco DeMonte ◽  
Paul W. Gidley
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Nerve Function ◽  
Middle Fossa ◽  
Facial Nerve Function ◽  
Middle Fossa Approach ◽  
Class A ◽  
Csf Leakage ◽  
Class B ◽  
Class C

Object In the early 1960s William F. House developed the middle fossa approach for the removal of small vestibular schwannomas (VSs) with the preservation of hearing. It is the best approach for tumors that extend laterally to the fundus of the internal auditory canal, although it does have the potential disadvantage of increased facial nerve manipulation, especially for tumors arising from the inferior vestibular nerve. The aim of this study was to monitor the hearing preservation and facial nerve outcomes of this approach. Methods A prospective database was constructed, and data were retrospectively reviewed. Results Between December 2004 and January 2012, 30 patients with small VSs underwent surgery via a middle fossa approach for hearing preservation. The patients consisted of 13 men and 17 women with a mean age of 46 years. Tumor size ranged from 7 to 19 mm. Gross-total resection was accomplished in 25 of 30 patients. Preoperative hearing was American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Class A in 21 patients, Class B in 5, Class C in 3, and undocumented in 1. Postoperatively, hearing was graded as AAO-HNS Class A in 15 patients, Class B in 7, Class C in 1, Class D in 2, and undocumented in 5. Facial nerve function was House-Brackmann (HB) Grade I in all patients preoperatively. Postoperatively, facial nerve function was HB Grade I in 28 patients, Grade III in 1, and Grade IV in 1. There were 3 complications: CSF leakage in 1 patient, superficial wound infection in 1, and extradural hematoma (asymptomatic) in 1. The overall hearing preservation rate of at least 73% and HB Grade I facial nerve outcome of 93% in this cohort are in keeping with other contemporary reports. Conclusions The middle fossa approach for the resection of small VSs with hearing preservation is a viable and relatively safe option. It should be considered among the various options available for the management of small, growing VSs.

scholarly journals Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach

Cureus ◽  
2018 ◽  
Author(s):  
Muhammad Shaheryar Ahmed Rajput ◽  
Ahmad Nawaz Ahmad ◽  
Asif Ali Arain ◽  
Mohammad Adeel ◽  
Saeed Akram ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Retrosigmoid Approach ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Facial Nerve Function

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

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.

Suboccipital Retrosigmoid Approach for Removal of Vestibular Schwannomas: Facial Nerve Function and Hearing Preservation

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. 560-570 ◽  
Author(s):  
Ivan Ciric ◽  
Jin-cheng Zhao ◽  
Sami Rosenblatt ◽  
Richard Wiet ◽  
Brian O'shaughnessy
Keyword(s):  
Prognostic Factors ◽  
Surgical Technique ◽  
Facial Nerve ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Neurophysiological Monitoring ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Neurovascular Anatomy

Abstract IN THIS REPORT, we discuss the pertinent bony, arachnoid, and neurovascular anatomy of vestibular schwannomas that has an impact on the surgical technique for removal of these tumors, with the goal of facial nerve and hearing preservation. The surgical technique is described in detail starting with anesthesia, positioning, and neurophysiological monitoring and continuing with the exposure, technical nuances of tumor removal, hemostasis, and closure. Positive prognostic factors for hearing preservation are also highlighted.

Schwannoma of the greater superficial petrosal nerve

2000 ◽  
Vol 122 (2) ◽  
pp. 302-303 ◽  
Author(s):  
Eugene N. Myers ◽  
Olaf Michel ◽  
Mathias Wagner ◽  
Orlando Guntinas-Lichius
Keyword(s):  
Facial Nerve ◽  
Geniculate Ganglion ◽  
Nerve Function ◽  
Middle Fossa ◽  
Facial Nerve Function ◽  
Progressive Hearing Loss ◽  
Middle Fossa Approach ◽  
Greater Superficial Petrosal Nerve ◽  
Intracranial Schwannoma ◽  
Ct And Mri

A case of an intracranial schwannoma originating from the greater superficial petrosal nerve with wide extension into the pterygopalatine fossa in a 20-year-old woman without neurofibromatosis is reported. The motor facial nerve including the geniculate ganglion was not affected. At presentation the patient had vertigo, progressive hearing loss, and mild facial nerve synkinesis without lacrimation deficit. The tumor was detected by CT and MRI. The tumor was completely removed with an intracranial, extradural middle fossa approach with complete preservation of the motor facial nerve function. To our knowledge, this is the first reported case of an isolated schwannoma of the greater superficial petrosal nerve without involvement of the motor facial nerve.

Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients

2006 ◽  
Vol 105 (4) ◽  
pp. 527-535 ◽  
Author(s):  
Madjid Samii ◽  
Venelin Gerganov ◽  
Amir Samii
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Neurological Status ◽  
Retrosigmoid Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Permanent Morbidity

Object The aim of this study was to evaluate and present the results of current surgical treatment of vestibular schwannomas (VSs) and to report the refinements in the operative technique. Methods The authors performed a retrospective study of 200 consecutive patients who had undergone VS surgery over a 3-year period. Patient records, operative reports, follow-up data, and neuroradiological findings were analyzed. The main outcome measures were magnetic resonance imaging, neurological status, patient complaints, and surgical complications. Complete tumor removal was achieved in 98% of patients. Anatomical preservation of the facial nerve was possible in 98.5% of patients. In patients treated for tumors with extension Classes T1, T2, and T3, the rate of facial nerve preservation was 100%. By the last follow-up examination, excellent or good facial nerve function had been achieved in 81% of the cases. By at least 1 year postsurgery, no patients had total facial palsy. In the patients with preserved hearing, the rate of anatomical preservation of the cochlear nerve was 84%. The overall rate of functional hearing preservation was 51%. There was no surgery-related permanent morbidity in this series of patients. Cerebrospinal fluid leakage was diagnosed in 2% of the patients. The mortality rate was 0%. Conclusions The goal of VS treatment should be total removal in one stage and preservation of neurological function, as they determine a patient’s quality of life. This goal can be safely and successfully achieved using the retrosigmoid approach.

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