Surgical Management of Intrinsic Tumors of the Facial Nerve

Abstract BACKGROUND Intrinsic tumors of the facial nerve are a rare entity. Dealing with this subset of tumors is challenging both in terms of decision making and surgical intervention. OBJECTIVE To review the outcomes of surgical management of facial nerve tumors and cable nerve graft interpositioning. METHODS A retrospective analysis was performed at a referral center for skull base pathology. One hundred fifteen patients who were surgically treated for facial nerve tumors were included. In case of nerve interruption during surgery, the cable nerve interpositioning technique was employed wherein the facial nerve palsy lasted for less than 1-yr duration. In cases of facial nerve palsy lasting for greater than 1 yr, the nerve was restituted by a hypoglossal facial coaptation. RESULTS Various degrees of progressive paralysis were seen in 84 (73%) cases. Sixty nine (60%) of the tumors involved multiple segments of the facial nerve. Sixty-two (53.9%) tumors involved the geniculate ganglion. Seventy four (64.3%) of the cases were schwannomas. Hearing preservation surgeries were performed in 60 (52.1%). Ninety one (79.1%) of the nerves that were sectioned in association with tumor removal were restituted primarily by interposition cable grafting. The mean preoperative House-Brackmann grading of the facial nerve was 3.6. The mean immediate postoperative grading was 5.4, which recovered to a mean of 3.4 at the end of 1 yr. CONCLUSION In patients with good facial nerve function (House-Brackmann grade I-II), a wait-and-scan approach is recommended. In cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve.

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Traumatic facial nerve palsy: evaluation and surgical management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202209 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1111

Author(s):

Chaitry K. Shah ◽

Shalu Gupta ◽

Bela J. Prajapati ◽

Devang P. Gupta ◽

Viral Prajapati

Keyword(s):

Facial Nerve ◽

Surgical Management ◽

Facial Palsy ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Cranial Nerves ◽

Surgical Decompression ◽

Nerve Function ◽

Good Recovery ◽

Facial Nerve Function

Background: Acute facial paralysis can result from various causes, among which intra temporal facial palsy is relatively common. Of all the cranial nerves, the facial nerve is most susceptible to injury due to its long course within the skull. Diagnosis of facial palsy is usually made by a good clinical history, examination and radiological investigations. Electrophysiological tests are important for prognosis and optimal time for surgery. The aim is to study the evaluation and surgical management in traumatic cause of facial nerve palsy.Methods: This prospective cross-sectional study was carried out in 50 patients presented with facial nerve palsy due to trauma in civil hospital Ahmedabad over a period of 1 year from May 2018 to 2019. Patients were examined and graded using House and Brackmann grading system. All the patients were evaluated and treated by surgical decompression. Follow up was carried out upto 6 months. Results: The cause of facial nerve palsy in all 50 patients was accidental head trauma. All the patients were managed by surgical decompression. 46 out of 50 patients managed surgically had good recovery with restoration of complete facial nerve function. 4 out 50 patients had poor recovery due to late presentation. Conclusions: Early initiation of treatment is important for favorable recovery of facial nerve function after trauma. Surgical treatment is indicated in suspected bony impingement of nerve. Surgical decompression if done early usually results in very good recovery.

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Predicting recovery of facial nerve function following injury from a basilar skull fracture

Journal of Neurosurgery ◽

10.3171/jns.1991.75.5.0759 ◽

1991 ◽

Vol 75 (5) ◽

pp. 759-762 ◽

Cited By ~ 15

Author(s):

Andrew B. Adegbite ◽

Moe I. Khan ◽

L. Tan

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Recovery Of Function ◽

Statistical Significance ◽

Complete Recovery ◽

Partial Recovery ◽

Nerve Function ◽

Facial Nerve Function ◽

Partial Lesion

✓ Twenty-five patients with posttraumatic facial nerve palsy were studied. Partial recovery of function had occurred in 95% of these patients by 18 months after injury. At 5 months posttrauma, there was some recovery in 92.5% of those with a partial lesion compared with 10% of those with a complete lesion. This difference attains statistical significance. Complete recovery of nerve function had occurred by 10.5 months in 53.5% of the patients; in 62% of patients with a partial lesion, complete recovery had occurred by 4 months compared with 0% in those with a complete lesion. This difference also attains statistical significance. There was no statistically significant difference in recovery of function between patients with an immediate as opposed to a delayed onset of facial nerve palsy. It was determined that the degree of palsy had a statistically significant influence on recovery of facial nerve function, whereas the time of onset did not. The data presented support a conservative approach to these injuries and it is recommended that the possibility of surgical treatment should be entertained in patients with complete facial palsy persisting for 12 to 18 months after injury.

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Idiopatic facial nerve palsy in pregnancy – facts and myths

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0012.1466 ◽

2018 ◽

Vol 7 (1) ◽

pp. 1-5

Author(s):

Anna Rzepakowska ◽

K Rybak ◽

Kazimierz Niemczyk ◽

P Rybak

Keyword(s):

Facial Nerve ◽

Pregnant Women ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Age Group ◽

Nerve Function ◽

Facial Nerve Function ◽

Facial Paresis ◽

Proven Efficacy ◽

Bell Palsy

Idiopathic facial nerve palsy, called also Bell palsy, can be a challenge for clinicians if a pregnant woman reports symptoms of facial paresis. The incidence of Bell's paralysis in pregnant women is almost three times higher than in the non-pregnant women's age group. The problem is the lack of guidelines for the treatment of idiopatic facial nerve palsy in this group of patients. In randomized studies, but without participation of pregnant women, greater efficacy was found in the return of nerve function after early treatment with corticosteroids than with other methods. The dilemma concerning therapy is intensified by the fact that the prognosis regarding the return of facial nerve function in pregnant women is significantly worse than in the remaining population and the weakness of facial muscles is yet diagnosed in a young woman. In the article we present the example of a patient consulted in our department and the review of current literature. We introduce recommendations for the treatment of pregnant women with facial nerve palsy. There are discussed benefits, advised medicines, doses, necessary precautions and potential side effects of corticosteroids, which are the only ones that have proven efficacy in the treatment of Bell's paralysis in pregnant women.

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Right sided facial palsy more common in males while left sided facial palsy more common in females

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20182456 ◽

2018 ◽

Vol 6 (7) ◽

pp. 2291

Author(s):

Gaurav Jain ◽

Virendra Verma

Keyword(s):

Facial Nerve ◽

Retrospective Analysis ◽

Facial Palsy ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Age Groups ◽

Age Group ◽

Males And Females ◽

The Mean ◽

Diagnosis Age

Background: The study describes the retrospective analysis of 54 cases of facial nerve palsy patients seen in our neurophysiology Laboratory during February 2016 to January 2018.Methods: Clinically diagnosed cases of facial nerve palsy encountered at neurophysiology laboratory were analyzed on the basis of their diagnosis, age, sex, side affected and their seasonal occurrence. Patients were grouped in to four age groups of <20 yr, 21-40 yr, 41-60 yr and >60 yr.Results: Out of total 54 facial palsy cases with the mean age of 34.39±14.25 yr, 29 (53.70%) were males and 25 (46.30%) were females. Facial palsy was most common in 21-40 yr age group (42.59%, n=23), followed by 41-60 yr age group (29.63%, n=16). Nearly equal number of cases of right sided (26; 48.15%) and left sided (28; 51.85%) facial palsy were observe. However, right side facial palsy was more common in males with right side to left side facial palsy ratio of 1.90:1 and left sided facial palsy was more common in females with right side to left side facial palsy ratio of 1:2.57.Conclusions: Facial palsy cases are uniformly distributed among males and females with preponderance of right facial palsy in males and left facial palsy in females.

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Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1607320 ◽

2017 ◽

Vol 79 (03) ◽

pp. 309-313 ◽

Cited By ~ 1

Author(s):

Michael Mooney ◽

Benjamin Hendricks ◽

Christina Sarris ◽

Robert Spetzler ◽

Randall Porter ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Tumor Diameter ◽

Nerve Function ◽

Facial Nerve Function ◽

Microsurgical Resection ◽

Grade Iii

Objectives This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design A retrospective review. Setting Single-institution cohort. Participants Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures Incidence, House–Brackmann grade. Results Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1–4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House–Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.

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Medical and surgical management of facial nerve palsy

Current Opinion in Ophthalmology ◽

10.1097/icu.0b013e3283313cbf ◽

2009 ◽

Vol 20 (6) ◽

pp. 440-450 ◽

Cited By ~ 12

Author(s):

Ribhi Hazin ◽

Babak Azizzadeh ◽

M Tariq Bhatti

Keyword(s):

Facial Nerve ◽

Surgical Management ◽

Nerve Palsy ◽

Facial Nerve Palsy

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

Neurosurgery ◽

10.1227/01.neu.0000154059.34990.b8 ◽

2005 ◽

Vol 56 (3) ◽

pp. 560-570 ◽

Cited By ~ 34

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.

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Delayed facial nerve palsy after vestibular schwannoma surgery

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v20i1.727 ◽

2018 ◽

Vol 20 (1) ◽

pp. 84-88

Author(s):

Walter J. Fagundes Pereyra ◽

Alonso Luis De Sousa ◽

Karlo Faria Nunes ◽

Deborah Nunes De Angeli

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Surgical Removal ◽

Electromyographic Activity ◽

Immunological Study ◽

Nerve Function ◽

Facial Nerve Function ◽

Nerve Dysfunction

Background: Facial nerve dysfunction may occur immediately after vestibular schwanoma surgery. Electromyographyc monitoring of motor cranial nerves during cerebellopontine angle surgery has become an essential tool. Although delayed onset of facial nerve dysfunction hours to months following vestibular schwanoma surgery are rare. Case description: We describe the case of a 70-years-old male who was admitted with a left side tinnitus and hearing loss of the last 3 years. Magnetic resonance imaging (MRI) T1-weighted demonstrated an isointensity lesion, 30mm in diameter, at the left cerebello-pontine angle with a small portion in the internal auditory canal. The patient was surgically treated by means of a standart suboccipital retrosigmoid approach. The facial nerve was monitored by continuously during surgery. Surgical removal was macroscopically complete. The facial nerve was well-preserved during surgery and showed at the end of the procedure normal electromyographic activity. The patient did well postoperatively and was discharged at the 4th postoperative day and facial function was normal (House-Brackmann grade I). On the 10th postoperative day he notices difficult closing his left eye that progressed to complete facial nerve palsy (House-Brackmann grade III). Steroid therapy was performed for five days associated with physical therapy. One month later his facial nerve function had completely recovered. After six months, the patient remains asymptomatic and neurologically intact. MRI obtained at the 16th postoperative day showed intense enhancement of the intracranial facial nerve segment and also demonstrated no residual tumor. Immunological study at the time of onset showed herpes simplex virus antibody titer normal as well as those for herpes zoster virus. Conclusions: Delayed facial nerve palsy remains an under reported and consequently not very known phenomenon in the neurosurgical practice and literature. Because of the 2009favorable rate of recovery, patients should be reassured in the interim and should not undergo any corrective surgical procedures to improve facial nerve function. Delayed facial nerve palsy is uncommon after vestibular schwannoma surgery. Excellent recovery of facial nerve function to the original postoperative status nearly always occurs in those circumstances.

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Delayed Facial Nerve Palsy after Middle Ear Surgery

Otolaryngology ◽

10.1016/j.otohns.2008.05.175 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P54-P54

Author(s):

Panagiotis N Papanikolaou ◽

John E Xenelis ◽

Thanos Bibas ◽

John V Sengas

Keyword(s):

Facial Nerve ◽

Middle Ear ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Chronic Otitis Media ◽

Middle Ear Surgery ◽

Nerve Function ◽

Facial Nerve Function ◽

Ear Surgery ◽

Profound Hearing Loss

Objective 1) Report the incidence and outcome of delayed facial nerve palsy following middle ear surgery in our department, and 2) review the medical literature. Methods This is a retrospective chart review study of 833 patients who were operated for chronic otitis media with cholesteatoma (572 patients), otosclerosis (192 patients), and profound hearing loss who received a cochlear implant (68 patients) since 1993. Results Delayed facial nerve palsy was observed in 10 patients (1.2%). In all cases, immediate postoperative facial nerve function was normal and the palsy occurred 5 to 8 days postoperatively. Facial nerve function recovered in all patients within 6 months. Assessment and management issues are discussed. Conclusions Delayed facial nerve palsy may rarely occur following middle ear surgery and has an excellent recovery rate.

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Facial nerve injury in acoustic neuroma (vestibular schwannoma) surgery: etiology and prevention

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.3.9 ◽

1998 ◽

Vol 5 (3) ◽

pp. E8 ◽

Cited By ~ 1

Author(s):

Prakash Sampath ◽

Michael J. Holliday ◽

Henry Brem ◽

John K. Niparko ◽

Donlin M. Long

Keyword(s):

Facial Nerve ◽

Nerve Injury ◽

Acoustic Neuroma ◽

Postoperative Period ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Nerve Function ◽

Facial Nerve Function ◽

Facial Nerve Injury ◽

Acoustic Neuroma Surgery

Facial nerve injury associated with acoustic neuroma surgery has declined in incidence but remains a clinical concern. A retrospective analysis of 611 patients surgically treated for acoustic neuroma between 1973 and 1994 was undertaken to understand patterns of facial nerve injury more clearly and to identify factors that influence facial nerve outcome. Anatomical preservation of the facial nerve was achieved in 596 patients (97.5%). In the immediate postoperative period, 62.1% of patients displayed normal or near-normal facial nerve function (House-Brackmann Grade 1 or 2). This number rose to 85.3% of patients at 6 months after surgery and by 1 year, 89.7% of patients who had undergone acoustic neuroma surgery demonstrated normal or near-normal facial nerve function. The surgical approach appeared to have no effect on the incidence of facial nerve injury. Poor facial nerve outcome (House-Brackmann Grade 5 or 6) was seen in 1.58% of patients treated via the suboccipital approach and in 2.6% of patients treated via the translabyrinthine approach. When facial nerve outcome was examined with respect to tumor size, there clearly was an increased incidence of facial nerve palsy seen in the immediate postoperative period in cases of larger tumors: 60.8% of patients with tumors smaller than 2.5 cm had normal facial nerve function, whereas only 37.5% of patients with tumors larger than 4 cm had normal function. This difference was less pronounced, however, 6 months after surgery, when 92.1% of patients with tumors smaller than 2.5 cm had normal or near normal facial function, versus 75% of patients with tumors larger than 4 cm. The etiology of facial nerve injury is discussed with emphasis on the pathophysiology of facial nerve palsy. In addition, on the basis of the authors' experience with these complex tumors, techniques of preventing facial nerve injury are discussed.

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