Facial Nerve Repair in Cerebellopontine Angle Surgery

1978 ◽  
Vol 87 (6) ◽  
pp. 772-777 ◽  
Author(s):  
Derald E. Brackmann ◽  
William E. Hitselberger ◽  
Jerald V. Robinson
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Cerebellopontine Angle ◽  
Nerve Repair ◽  
Nerve Graft ◽  
Tumor Removal ◽  
Stylomastoid Foramen ◽  
Substitution Procedure ◽  
The Brain ◽  
Facial Function

Facial nerve continuity was restored during cerebellopontine angle tumor removal in nine cases. The distal facial nerve was rerouted from the stylomastoid foramen into the cerebellopontine angle. Direct suture was accomplished in seven cases while two required interposition of a greater auricular nerve graft. There was excellent return of facial function in eight of the nine cases. Overall results are superior to nerve substitution techniques. The facial nerve should be inspected for continuity following tumor removal. If one is not certain the nerve is intact, the proximal facial stump should be identified at the brain stem and facial nerve continuity reestablished. A nerve substitution procedure should be resorted to at a later time only when the proximal facial stump is not identifiable.

Suboccipital Surgical Approach to the Cerebellopontine Angle and Internal Auditory Canal

1978 ◽  
Vol 71 (4) ◽  
pp. 273-274 ◽  
Author(s):  
Mansfield F W Smith
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Prone Position ◽  
Surgical Approach ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Total Removal ◽  
Size And Shape ◽  
Suboccipital Craniectomy ◽  
The Brain

The suboccipital craniectomy done with the patient in the prone position using modern microsurgical methods gives good anatomical exposure essential for efficient, accurate, total removal of cerebellopontine angle neoplasms and allows adjacent. uninvolved neurological structures to be spared. Modifying the anatomical exposure by varying the size and shape of the osseous craniectomy and placing the dural incision closer to the porus acousticus permits extradural retraction of the cerebellum. Thus large cerebellopontine angle neoplasms can be excised with less chance of damage to the cerebellum and smaller risk of hydrocephalus. The suboccipital craniectomy may be extended anteriorly to the facial nerve, thereby combining the suboccipital with the translabyrinthine approach. and providing a more direct angle to a large neoplasm involving the brain stem and cerebellum.

Large Intratemporal Facial Nerve Schwannoma without Facial Palsy: Surgical Strategy of Tumor Removal and Functional Reconstruction

2018 ◽  
Vol 79 (06) ◽  
pp. 528-532
Author(s):  
Sertac Yetiser
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Surgical Strategy ◽  
Clinical Aspects ◽  
Nerve Reconstruction ◽  
Tumor Removal ◽  
Stylomastoid Foramen ◽  
Facial Nerve Reconstruction ◽  
Facial Nerve Schwannoma ◽  
Facial Function

Background Three patients with large intratemporal facial schwannomas underwent tumor removal and facial nerve reconstruction with hypoglossal anastomosis. The surgical strategy for the cases was tailored to the location of the mass and its extension along the facial nerve. Aim To provide data on the different clinical aspects of facial nerve schwannoma, the appropriate planning for management, and the predictive outcomes of facial function. Patients Three patients with facial schwannomas (two men and one woman, ages 45, 36, and 52 years, respectively) who presented to the clinic between 2009 and 2015 were reviewed. They all had hearing loss but normal facial function. All patients were operated on with radical tumor removal via mastoidectomy and subtotal petrosectomy and simultaneous cranial nerve (CN) 7– CN 12 anastomosis. Results Multiple segments of the facial nerve were involved ranging in size from 3 to 7 cm. In the follow-up period of 9 to 24 months, there was no tumor recurrence. Facial function was scored House-Brackmann grades II and III, but two patients are still in the process of functional recovery. Conclusion Conservative treatment with sparing of the nerve is considered in patients with small tumors. Excision of a large facial schwannoma with immediate hypoglossal nerve grafting as a primary procedure can provide satisfactory facial nerve function. One of the disadvantages of performing anastomosis is that there is not enough neural tissue just before the bifurcation of the main stump to provide neural suturing without tension because middle fossa extension of the facial schwannoma frequently involves the main facial nerve at the stylomastoid foramen. Reanimation should be processed with extensive backward mobilization of the hypoglossal nerve.

Facial nerve preservation in patients with large acoustic neuromas treated by a combined middle fossa transtentorial translabyrinthine approach

1982 ◽  
Vol 57 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Charles H. Tator ◽  
Julian M. Nedzelski
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Cerebellopontine Angle ◽  
Middle Fossa ◽  
Total Removal ◽  
Content Type ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
The Brain ◽  
Fine Print

✓ With large acoustic neuromas, the primary goal of surgery is safe total removal of the tumors, and the secondary goal is preservation of nearby neural structures, including the facial nerve. In a series of 15 consecutive patients with large cerebellopontine angle tumors, all of which were more than 2.5 cm in diameter, tumor excision was performed by a one-stage combined middle fossa-translabyrinthine approach. There were 13 acoustic neuromas, 10 of which were more than 4 cm in diameter, one petrous apex meningioma 4 cm in diameter, and one facial neuroma 3 cm in diameter. The tumors were totally removed in all 15 patients. The facial nerve was preserved in 12 of 13 evaluable patients. In the 14th patient the nerve had been transected in a previous suboccipital procedure with incomplete removal, and in the 15th patient the nerve was sutured following excision of a facial neuroma. Thus, the nerve was lost at surgery in only one patient. This combined approach provided very clear visualization of the cerebellopontine angle, including the brain stem and the lower cranial nerves. It enabled identification of both the origin of the facial nerve at the brain stem and the lateral segment of the nerve in the internal auditory canal. Anterior extensions of tumor growing through the tentorial hiatus were easily removed. The results in these 15 patients show that this approach is excellent for total removal of large acoustic neuromas with preservation of the facial nerve. It is especially suitable for large tumors with anterior extensions.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Long-term functional outcome in facial nerve graft by fibrin glue in the temporal bone and cerebellopontine angle

2004 ◽  
Vol 262 (5) ◽  
pp. 404-407 ◽  
Author(s):  
Alexis Bozorg Grayeli ◽  
Isabelle Mosnier ◽  
Nicolas Julien ◽  
Hani Garem ◽  
Didier Bouccara ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Functional Outcome ◽  
Temporal Bone ◽  
Fibrin Glue ◽  
Cerebellopontine Angle ◽  
Nerve Graft

Facial Nerve Neuroma

1994 ◽  
Vol 73 (10) ◽  
pp. 721-752 ◽  
Author(s):  
Jack L. Pulec
Keyword(s):  
Facial Nerve ◽  
Signs And Symptoms ◽  
Middle Cranial Fossa ◽  
Nerve Graft ◽  
Surgical Removal ◽  
Optimal Conditions ◽  
Anatomic Site ◽  
Cranial Fossa ◽  
Slow Growing ◽  
Facial Function

Facial nerve neuromas are uncommon, slow-growing neoplasms that may occur anywhere along the course of the facial nerve from the brainstem to the facial muscles. The signs and symptoms are characteristic and vary with the anatomic site of origin. Surgery should not be attempted until a complete and thorough diagnostic examination has been completed. The surgeon should be prepared to perform a middle-cranial fossa or translabyrinthine approach in all cases, and must expect to do a nerve graft. The results of 37 patients treated by the author reveal that, under optimal conditions, patients who have had a facial nerve graft, can be expected to regain an average of 80 % facial nerve strength in almost every case. All patients who have had a facial nerve graft will have some degree of synkinesis. No graft was required in 3 patients, and a hypoglossal facial anastomosis was used for one. Facial function was completely normal in 2 patients, 16 had 80 – 90 % return, 5 patients had 50 – 80 % return, 4 had 20 – 50% return, one had no recovery at all and 9 recent patients have not reached the time for their expected recovery. Early diagnosis, prompt surgical removal and VII - VII Nerve graft for facial paralysis of ten or fewer years duration offers patients the best opportunity to avoid a permanent facial palsy.

Causes of Facial Nerve Paresis after Translabyrinthine Surgery for Acoustic Neuroma

1992 ◽  
Vol 101 (10) ◽  
pp. 821-826 ◽  
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.

Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes

2016 ◽  
Vol 37 (6) ◽  
pp. 493-496 ◽  
Author(s):  
Robert J. Yawn ◽  
Harry V. Wright ◽  
David O. Francis ◽  
Scott Stephan ◽  
Marc L. Bennett
Keyword(s):  
Facial Nerve ◽  
Nerve Repair ◽  
Nerve Graft

Hemifacial Spasm: Treatment by Microsurgical Facial Nerve Decompression

Neurosurgery ◽  
1983 ◽  
Vol 13 (2) ◽  
pp. 141-146 ◽  
Author(s):  
John D. Loeser ◽  
James Chen
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Surgical Therapy ◽  
Hemifacial Spasm ◽  
Surgical Patients ◽  
Facial Weakness ◽  
Nerve Decompression ◽  
The Brain ◽  
Facial Nerve Decompression

Abstract The literature on hemifacial spasm and its surgical therapy is reviewed, and the authors' experiences with 20 patients are described. Vascular cross compression of the facial nerve adjacent to the brain stem is seen in 90% of the surgical patients. Mobilizing the offending vessel will cure or significantly improve approximately 80% of the patients. Complications occur in 25% of the patients and usually involve decreased hearing or facial weakness. Mortality is virtually zero, and this operation is vastly superior to any other medical or surgical therapy for hemifacial spasm. The pathophysiology is not yet understood.

Facial Nerve Repair by Interposition Nerve Graft

Neurosurgery ◽  
1992 ◽  
Vol 31 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Erick Stephanian ◽  
Laligam N. Sekhar ◽  
Ivo P. Janecka ◽  
Barry Hirsch
Keyword(s):  
Facial Nerve ◽  
Nerve Repair ◽  
Nerve Graft
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