Glomus Vagale Tumor Resection: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E57-E57 ◽  
Author(s):  
Daniel M Heiferman ◽  
Esther A Cheng ◽  
Michael E Harkins ◽  
Matthew R Reynolds ◽  
Richard W Borrowdale ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Infratemporal Fossa ◽  
Tumor Resection ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Resonance Imaging

Abstract A 37-yr-old female with prior transient left facial paralysis presented with hearing loss, headaches, and resolved transient right facial paralysis. The neurological examination demonstrated normal facial movement, left hearing loss, and left vocal cord weakness. Magnetic resonance imaging demonstrated a >3 cm left paraganglioma traversing the jugular foramen. After obtaining informed consent from the patient, the tumor was embolized and then resected via a combined left postauricular infratemporal fossa and transcervical approach with cranial nerve monitoring. The ossicles were removed and the vertical segment of the facial nerve was skeletonized. The jugular bulb was identified in the hypotympanum and the petrous carotid artery was exposed. The digastric muscle was reflected inferiorly and the extratemporal facial nerve was identified. The stylomandibular ligament was transected to unlock the exposure to the infratemporal fossa. The external carotid branches were ligated. The vagus nerve and cervical sympathetic chain were infiltrated with tumor, requiring resection. The presigmoid dura and occluded jugular bulb were opened to complete the tumor resection, while preserving the medial wall. Despite anatomic preservation, the glossopharyngeal, accessory, and hypoglossal nerves were postoperatively weak and a facial paralysis recovered after 1 wk. Magnetic resonance imaging at 1 yr demonstrated a clean jugular foramen, although a thin rim of tumor remained around the petrous carotid.

Microsurgical Resection of Glomus Jugulare Tumors With Facial Nerve Reconstruction: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E1-E1 ◽  
Author(s):  
Duarte N C Cândido ◽  
Jean Gonçalves de Oliveira ◽  
Luis A B Borba
Keyword(s):  
Facial Nerve ◽  
Infratemporal Fossa ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Senior Author ◽  
Nerve Reconstruction ◽  
Glomus Jugulare ◽  
Carotid Canal

Abstract Paragangliomas are tumors originating from the paraganglionic system (autonomic nervous system), mostly found at the region around the jugular bulb, for which reason they are also termed glomus jugulare tumors (GJT). Although these lesions appear to be histologically benign, clinically they present with great morbidity, especially due to invasion of nearby structures such as the lower cranial nerves. These are challenging tumors, as they need complex approaches and great knowledge of the skull base. We present the case of a 31-year-old woman, operated by the senior author, with a 1-year history of tinnitus, vertigo, and progressive hearing loss, that evolved with facial nerve palsy (House-Brackmann IV) 2 months before surgery. Magnetic resonance imaging and computed tomography scans demonstrated a typical lesion with intense flow voids at the jugular foramen region with invasion of the petrous and tympanic bone, carotid canal, and middle ear, and extending to the infratemporal fossa (type C2 of Fisch's classification for GJT). During the procedure the mastoid part of the facial nerve was identified involved by tumor and needed to be resected. We also describe the technique for nerve reconstruction, using an interposition graft from the great auricular nerve, harvested at the beginning of the surgery. We achieved total tumor resection with a remarkable postoperative course. The patient also presented with facial function after 6 months. The patient consented with publication of her images.

Magnetic Resonance Imaging of the Facial Nerve in Peripheral Facial Paralysis

2002 ◽  
Vol 23 (Sup 1) ◽  
pp. S36-S37
Author(s):  
Sertac Yetiser ◽  
Mustafa Kazkayasi ◽  
Deniz Altinok ◽  
Yasemin Karadeniz
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Resonance Imaging ◽  
Peripheral Facial Paralysis

The Use of Magnetic Resonance Imaging with High-Resolution CT in the Evaluation of Facial Paralysis

1989 ◽  
Vol 101 (4) ◽  
pp. 449-458 ◽  
Author(s):  
Mitchell K. Schwaber ◽  
David Zealear ◽  
James L. Netterville ◽  
Michael Seshul ◽  
Robert H. Ossoff
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Case Reports ◽  
Resonance Imaging ◽  
High Resolution Computed Tomography ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

Magnetic resonance imaging (MRI) has been widely used in the evaluation of suspected acoustic neuroma, but has not received the same attention with respect to facial paralysis. High-resolution computed tomography (HRCT) has been the radiologic test of choice to evaluate the facial nerve. The necessary HRCT projections, slices, and enhancement techniques to visualize each segment have been outlined. We have developed a radiologic protocol that uses MRI in conjunction with HRCT, applying the strengths of each to evaluate the facial nerve. We have evaluated 15 patients and have found that MRI is the better study to evaluate the brain stem/cerebellopontine angle segment of the facial nerve and better evaluates bone-soft tissue Interfaces. HRCT is better in the evaluation of the intratemporal segment of the facial nerve and the assessment of the anatomic perspectives of a lesion within the temporal bone. The results are discussed and case reports Illustrate the efficacy of this approach.

Magnetic resonance imaging of the facial nerve in children with idiopathic facial paralysis☆

2000 ◽  
Vol 122 (4) ◽  
pp. 556-559 ◽  
Author(s):  
DON L. BURGIO ◽  
SHOAB SIDDIQUE ◽  
MICHAEL HAUPERT ◽  
ROBERT J. MELECA
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Resonance Imaging

scholarly journals High resolution magnetic resonance imaging for exposing facial nerve zonal vulnerability to microbleeds: A rare cause of facial palsy

2017 ◽  
Vol 30 (4) ◽  
pp. 385-388
Author(s):  
Charlie Chia-Tsong Hsu ◽  
Dalveer Singh ◽  
Trevor William Watkins ◽  
Gigi Nga Chi Kwan ◽  
Sachintha Hapugoda
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Internal Auditory Canal ◽  
Sudden Onset ◽  
Partial Recovery ◽  
Resonance Imaging ◽  
Rapid Acquisition

Background We report a case of hypertensive microbleeds strategically located at the attached segment (AS) and root entry zone (REZ) at the left facial nerve causing facial paralysis. Case Report A 60-year-old woman presented with sudden onset left facial paralysis. Medical history was significant for poorly controlled hypertension secondary to bilateral adrenal hyperplasia (primary hyperaldosteronism). The patient was initially treated for presumptive Bell’s palsy. Subsequent magnetic resonance imaging of the brain and internal auditory canal showed two microbleeds at the left cerebellopontine angle. Dedicated coronal T1 magnetization prepared rapid acquisition gradient echo and T2 sampling perfection with application optimized contrasts using different flip angle evolution sequences revealed two acute microbleeds located at the attached AS and REZ of the left facial nerve. The patient experienced only partial recovery from House–Brackmann grade IV facial paralysis at presentation to a House–Brackmann grade III facial paralysis at 1 year of follow up. Conclusions To the best of the authors’ knowledge, this is the first reported case of facial paralysis caused by microbleeds directly affecting the vulnerable AS and REZ facial nerve segments. We discuss the zonal microanatomy of the facial nerve and the crucial role of high resolution MRI for diagnosis.

LINEAR ACCELERATOR-BASED STEREOTACTIC RADIOSURGERY FOR BILATERAL VESTIBULAR SCHWANNOMAS IN PATIENTS WITH NEUROFIBROMATOSIS TYPE 2

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_5) ◽  
pp. A37-A43 ◽  
Author(s):  
Otto W.M. Meijer ◽  
W. Peter Vandertop ◽  
Frank J. Lagerwaard ◽  
Ben J. Slotman
Keyword(s):  
Magnetic Resonance Imaging ◽  
At Risk ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Linear Accelerator ◽  
Pure Tone ◽  
Neurofibromatosis Type ◽  
Resonance Imaging

ABSTRACT OBJECTIVE Patients with neurofibromatosis Type 2 (NF2) patients typically have bilateral vestibular schwannomas (VS) and are at risk for developing bilateral deafness, bilateral trigeminal, and bilateral facial nerve function loss. Previous reports suggested that treatment outcomes in these patients are worse compared with those for patients with sporadic solitary VS. Very few reports, however, have been published on linear accelerator-based radiosurgery (RS) and stereotactic radiation therapy (SRT) in patients with NF2. In particular, in patients with NF2 who already have unilateral hearing loss, avoidance of hearing loss on the opposite side poses a challenge for RS and SRT. We studied our treatment results in patients with NF2 with bilateral VS, treated with linear accelerator-based RS and SRT. METHODS In 204 patients with VS treated with RS or SRT in Amsterdam starting from 1992, we identified 25 patients with NF2 who had bilateral tumors. Indications for treatment were either tumor progression on sequential magnetic resonance imaging scans and/or progressive hearing loss. Mean tumor diameter was 2.5 cm. Stereotactic irradiation was administered to all patients using five noncoplanar arcs with a single isocenter to a dose of 10 to 12.5 Gy in a single fraction or 20 to 25 Gy in five fractions in 1 week prescribed to the 80% isodose encompassing the tumor. On the untreated side, all patients showed hearing loss and eight (32%) had ipsilateral deafness. Five patients were followed for less than 1 year. Of the remaining 20 patients, five had ipsilateral deafness before treatment. Consequently, 15 patients were at risk for treatment-related hearing loss. They showed a mean pure tone average (PTA) of 51 dB (8–112 dB) before treatment. After treatment all patients were assessed at yearly intervals including magnetic resonance imaging and pure tone audiometry. RESULTS Median follow-up time was 51 months (12–109 mo). Local tumor control was obtained in all 20 patients, and no treatment-related trigeminal or facial nerve toxicity was observed. Hearing status was assessed yearly after treatment. This assessment revealed that the mean PTA in the 15 hearing patients dropped from 51 to 77 dB (40–120 dB). In six patients (40%) the additional PTA loss ranged from 0 to 15 dB, in another six (40%) it ranged from 15 to 45 dB, and in three of these patients (20%), it was more than 45 dB. No additional hearing loss was observed beyond 36 months after treatment. CONCLUSION In this largest series in the literature of linear accelerator-based RS and SRT for VS NF2 patients, excellent local control rates were found with minimal facial and trigeminal nerve toxicity. Although more than 40% of the patients retained their hearing level or lost less than 15 dB of PTA on the irradiated side, preservation of hearing remains a major concern.

scholarly journals Intraparotid Facial Nerve Schwannoma with Temporal Bone Extension

2012 ◽  
Vol 27 (1) ◽  
pp. 23-27
Author(s):  
Alexander T. Laoag ◽  
Antonio H. Chua ◽  
Thanh Vu T. De Guzman ◽  
Samantha S. Castañeda ◽  
Jose A. Malanyaon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Tumor Resection ◽  
Facial Nerve Paralysis ◽  
Resonance Imaging ◽  
Nerve Paralysis ◽  
Nerve Tumor ◽  
Facial Nerve Schwannoma

Objective: To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment.Methods:     Design: Case Report     Setting: Tertiary Government Hospital     Patient: OneResults: A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy withfacial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved.Conclusion: A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin.Keywords: intraparotid facial nerve schwannoma, facial nerve paralysis, parotid mass

Magnetic resonance imaging of the facial nerve in children with idiopathic facial paralysis

2000 ◽  
Vol 122 (4) ◽  
pp. 556-559
Author(s):  
Don L. Burgio ◽  
Shoab Siddique ◽  
Michael Haupert ◽  
Robert J. Meleca
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Recovery Time ◽  
Time Course ◽  
Resonance Imaging ◽  
Yield Information ◽  
Facial Function

The role of gadolinium-enhanced MRI (Gd-MRI) in the diagnosis of idiopathic facial paralysis (IFP) in children is not well defined. Fourteen children with IFP were evaluated to assess the use of Gd-MRI for the presence and pattern of enhancement and its usefulness in predicting the recovery of facial function. Six of 14 children had enhancement of the facial nerve on Gd-MRI, whereas 8 had none. Enhancement was noted in the tympanic, mastoid, and most commonly in the distal intracanalicular and labyrinthine segments. The average time from onset of paresis to recovery in patients with enhancement was 19.3 weeks, whereas in those with no enhancement, mean recovery time was 9.5 weeks ( P = 0.003, t test). All 14 patients eventually had recovery to House-Brackmann grade I or II. Gd-MRI is not required for all children with IFP but may yield information about the time course of recovery of facial function.

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