Skull Base Schwannoma

2018 ◽  
Author(s):  
Joshua Lucas ◽  
Dawn Fishback ◽  
Steven Giannotta
Keyword(s):  
Hearing Loss ◽  
Differential Diagnosis ◽  
Facial Nerve ◽  
Skull Base ◽  
Treatment Options ◽  
Intraoperative Neuromonitoring ◽  
Unilateral Hearing Loss ◽  
Nerve Function ◽  
Published Evidence ◽  
Time Assessment

This chapter presents a case example of a patient with progressive unilateral hearing loss who was ultimately diagnosed with a skull base schwannoma. The workup and differential diagnosis are presented and options for treatment are reviewed based on published evidence. Treatment options include observation, stereotactic radiosurgery, and surgical resection. The objective status of a patient’s hearing as well as the patient’s age influence treatment recommendations and the surgical approach. Intraoperative neuromonitoring provides real-time assessment of facial nerve irritation as well as cochlear nerve function and is an important component of surgery. Complication avoidance and management are also discussed in this chapter.

scholarly journals Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

2018 ◽  
Vol 128 (2) ◽  
pp. 631-638 ◽  
Author(s):  
Sampath Chandra Prasad ◽  
Karthikeyan Balasubramanian ◽  
Enrico Piccirillo ◽  
Abdelkader Taibah ◽  
Alessandra Russo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Skull Base Tumor ◽  
Nerve Function ◽  
Postoperative Result ◽  
Lateral Skull Base ◽  
Number Of Patients ◽  
Study Results ◽  
Grade Iii

OBJECTIVEThe aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries.METHODSThe authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system.RESULTSTwo hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002).CONCLUSIONSCable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue–aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.

scholarly journals Quantification of Speech-in-Noise and Sound Localisation Abilities in Children with Unilateral Hearing Loss and Comparison to Normal Hearing Peers

2015 ◽  
Vol 20 (Suppl. 1) ◽  
pp. 31-37 ◽  
Author(s):  
Ruth M. Reeder ◽  
Jamie Cadieux ◽  
Jill B. Firszt
Keyword(s):  
Hearing Loss ◽  
Treatment Options ◽  
Low Frequency ◽  
Normal Hearing ◽  
Unilateral Hearing Loss ◽  
Study Objective ◽  
Speech In Noise ◽  
Sound Localisation ◽  
Noise Type ◽  
Gender And Age

The study objective was to quantify abilities of children with unilateral hearing loss (UHL) on measures that address known deficits for this population, i.e. speech understanding in quiet and noise, and sound localisation. Noise conditions varied by noise type and source location. Parent reports of real-world abilities were also obtained. Performance was compared to gender- and age-matched normal hearing (NH) peers. UHL performance was poorer and more varied compared to NH peers. Among the findings, age correlated with localisation ability for UHL but not NH participants. Low-frequency hearing in the better ear of UHL children was associated with performance in noise; however, there was no relation for NH children. Considerable variability was evident in the outcomes of children with UHL and needs to be understood as future treatment options are considered.

scholarly journals A Rare Case of a Sebaceous Nevus in the External Auditory Canal

2003 ◽  
Vol 82 (1) ◽  
pp. 38-41 ◽  
Author(s):  
Nici Eddy Bothwell ◽  
Craig C. Willard ◽  
Douglas M. Sorensen ◽  
Timothy J. Downey
Keyword(s):  
Hearing Loss ◽  
Differential Diagnosis ◽  
External Auditory Canal ◽  
Rare Case ◽  
Unilateral Hearing Loss ◽  
Essential Information ◽  
Secondary Neoplasm ◽  
The Face ◽  
Three Stages ◽  
Different Characteristics

We report the case of a patient who came to us for evaluation of a progressive unilateral hearing loss and who was found to have a sebaceous nevus in an unusual location: the external auditory canal. A sebaceous nevus is a congenital organoid mass that occurs primarily on the face, scalp, and periauricular regions. Despite the predilection of sebaceous nevi for the head and neck, reports of this lesion rarely appear in the otolaryngology literature. Left untreated, the lesion can progress through three stages of gross and histopathologic development; a sebaceous nevus begins as a small benign papule, grows into an enlarging mass with different characteristics, and ultimately becomes a secondary neoplasm. The lesion's potential for malignant transformation and its association with syndromes underscores the importance of prompt recognition and appropriate management. This case report adds the sebaceous nevus to the differential diagnosis of external auditory canal lesions and provides essential information about this rare mass.

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.

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.

Delayed Hearing Loss after Neurovascular Decompression

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 997-1003 ◽  
Author(s):  
Dennis E. McDonnell ◽  
Bahman Jabbari ◽  
Giovana Spinella ◽  
Gustave H. Mueller ◽  
Peter M. Klara
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Cerebellopontine Angle ◽  
Unilateral Hearing Loss ◽  
Neurovascular Compression ◽  
Bilateral Hearing Loss ◽  
First Case ◽  
Neurovascular Decompression ◽  
Vascular Decompression

Abstract We report two unusual cases of delayed hearing loss after neurovascular decompression of structures within the cerebellopontine angle. In the first case, the patient noted a unilateral hearing loss 3 weeks after undergoing vascular decompression of the trigeminal nerve for tic douloureux. This gradually improved over an 18-month period. In the second case, the patient awoke on the 4th day after vascular decompression of the facial nerve for hemifacial spasm with a bilateral hearing loss that has remained unchanged after the onset. These are examples of delayed acoustic dysfunction occurring with a shift in surgically freed vessels and may have been induced by newly directed neurovascular compression or distortion.

Surgical management of vestibular schwannoma: attempted preservation of hearing and facial function

2013 ◽  
Vol 127 (5) ◽  
pp. 473-478 ◽  
Author(s):  
T F Youssef ◽  
A Matter ◽  
M R Ahmed
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Tumour Size ◽  
Treatment Options ◽  
University Hospital ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Function ◽  
Stereotactic Radiation ◽  
Viiith Cranial Nerve

AbstractBackground:Vestibular schwannomas are benign tumours which usually originate from the vestibular portion of the VIIIth cranial nerve. Treatment options include observation with serial imaging, stereotactic radiation and microsurgical removal.Aim:The goal of surgery was complete eradication of tumour with preservation of hearing and facial nerve function.Methods:A retrospective review was undertaken of 24 cases of vestibular schwannoma jointly operated upon by a team of neurosurgeons and otologists at the Suez Canal University Hospital, with assessment of VIIth and VIIIth cranial nerve function, tumour size, and extent of growth. All surgery utilised a retromastoid, suboccipital approach.Results:Complete tumour removal was achieved in 19 patients. Anatomical preservation of the facial nerve was possible in 66.6 per cent of patients. Pre-operative, useful hearing was present in four patients, and preserved in 80 per cent. Cerebrospinal fluid leakage was diagnosed in two (8.3 per cent) patients, who responded to conservative therapy.Conclusion:The retromastoid, suboccipital surgical approach to the skull base can be safely and successfully achieved using a microsurgical technique, with minimal or no damage to neurovascular structures, even for large tumours.

scholarly journals Facial nerve motor evoked potentials during skull base surgery to monitor facial nerve function using the threshold-level method

2013 ◽  
Vol 34 (3) ◽  
pp. E7 ◽  
Author(s):  
Johannes Sarnthein ◽  
Nader Hejrati ◽  
Marian C. Neidert ◽  
Alexander M. Huber ◽  
Niklaus Krayenbühl
Keyword(s):  
At Risk ◽  
Facial Nerve ◽  
Evoked Potentials ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Motor Evoked Potentials ◽  
Threshold Level ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Level Method

Object During surgeries that put the facial nerve at risk for injury, its function can be continuously monitored by transcranial facial nerve motor evoked potentials (FNMEPs) in facial nerve target muscles. Despite their advantages, FNMEPs are not yet widely used. While most authors use a 50% reduction in FNMEP response amplitudes as a warning criterion, in this paper the authors' approach was to keep the response amplitude constant by increasing the stimulation intensity and to establish a warning criterion based on the “threshold-level” method. Methods The authors included 34 consecutive procedures involving 33 adult patients (median age 47 years) in whom FNMEPs were monitored. A threshold increase greater than 20 mA for eliciting FNMEPs in the most reliable facial nerve target muscle was considered a prediction of reduced postoperative facial nerve function, and subsequently a warning was issued to the surgeon. Preoperative and early postoperative function was documented using the House-Brackmann grading system. Results Monitoring of FNMEPs was feasible in all 34 surgeries in at least one facial nerve target muscle. The mentalis muscle yielded the best results. The House-Brackmann grade deteriorated in 17 (50%) of 34 cases. The warning criterion was reached in 18 (53%) of 34 cases, which predicted an 83% risk of House-Brackmann grade deterioration. Sensitivity amounted to 88% (CI 64%–99%) and specificity to 82% (CI 57%–96%). Deterioration of FNMEPs and a worse House-Brackmann grade showed a high degree of association (p < 0.001). The impact of FNMEP monitoring on surgical strategy is exemplified in an illustrative case. Conclusions In surgeries that put the facial nerve at risk, the intraoperative increase in FNMEP stimulation threshold was closely correlated to postoperative facial nerve dysfunction. Monitoring of FNMEPs is a valid indicator of facial nerve function in skull base surgery. It should be used as an adjunct to direct electrical facial nerve stimulation and continuous electromyographic monitoring of facial nerve target muscles.

Intra-operative facial nerve monitoring. Its predictive value after skull base surgery

1997 ◽  
Vol 111 (8) ◽  
pp. 715-718 ◽  
Author(s):  
Giuseppe Magliulo ◽  
Francesco Zardo
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Predictive Value ◽  
Skull Base Surgery ◽  
Evoked Response ◽  
Nerve Function ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Stimulation Current ◽  
Facial Function

AbstractPurposeFacial nerve monitoring can be used to predict post-operative facial function after skull base surgery. In this study three methods of prediction of facial function were compared. These methods utilize various parameters of the evoked electromyographic monitoring.Material and methodsTwenty-three patients who underwent surgery for skull base diseases were retrospectively reviewed. Amplitude of ongoing electromyographic activity, stimulation current thresholds and amplitude of evoked response were analysed. The predictive value of the three methods was correlated with post-operative facial nerve function.ResultsThe method that used only the stimulation thresholds predicted the final post-operative facial function in 86.9 per cent of the patients. The second employed a mathematical ratio which combined the amplitude of evoked response and the stimulation current thresholds and confirmed the prediction of the facial function in 91.3 per cent of the patients. The last method does not consider the stimulation thresholds greater than 0.05 mA and failed to predict the final VIIth nerve function in patients in whom the stimulation was greater than 0.05 mA.ConclusionAnalysis of prognostic value demonstrates that the first two methods had the smaller degree of variation showing the better sensitivity.

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