Facial and Cochlear Nerve Function after Surgery of Cerebellopontine Angle Meningiomas

Abstract OBJECTIVE: Meningiomas of the cerebellopontine angle (CPA) share a common location, but their site of dural origin and their relationship to surrounding neurovascular structures of the CPA are variable. The clinical presentation and outcome after surgical resection are different because of the diversity of this tumor entity. We report on a series of 421 patients with CPA meningiomas, with special emphasis on the analysis of the preoperative and postoperative facial and cochlear nerve function in relation to the site of dural attachment and main tumor location in the CPA cistern. METHODS: Among 421 patients, the charts of 347 patients with complete clinical data, including the history and audiograms, imaging studies, surgical records, discharge letters, histological records, and follow-up records, were reviewed retrospectively. Data about preoperative and postoperative facial nerve function were available in 334 patients, and audiometric analysis was conducted in 333 patients. Patients with neurofibromatosis Type 2 were excluded from the study. RESULTS: There were 270 women and 77 men, with a mean age of 53.4 years (range, 17.6–84 yr). Among these patients, 32.9% of the tumors originated at the petrous ridge anterior to the inner auditory canal (IAC) (Group 1), 22.2% showed involvement of the IAC (Group 2), 20.2% were located superior to the IAC (Group 3), 11.8% were inferior to the IAC (Group 4), and 12.9% were posterior to the IAC, originating between the IAC and the sigmoid sinus (Group 5). Patients presented with disturbance of Cranial Nerves V–VIII, the lower cranial nerves, and ataxia, depending on the main tumor location. Tumor resection was performed through a suboccipital-retrosigmoidal approach in the semisitting position in 95% of the patients. A combined supratentorial-infratentorial presigmoidal approach was performed in 5%. Total tumor removal (Simpson Grade 1 and 2) was achieved in 85.9% and subtotal removal in 14.1%. The best initial postoperative facial and auditory nerve function was observed in tumors belonging to Groups 3 and 5. Recovery from preoperative deafness was observed in 1.8% of patients. On long-term follow-up, good facial nerve function (House-Brackmann Grade 1 or 2) was observed in 88.9% of patients. Hearing preservation among patients with preoperative functional hearing was documented in 90.8% on long-term follow-up. CONCLUSION: Although the outcome of facial and cochlear nerve function is different in CPA meningiomas, depending on the topographic classification of these tumors, preservation of the cochlear nerve is possible in every tumor group and should be attempted in every patient with CPA meningioma. It has to be kept in mind that recovery of hearing was also observed in patients with preoperative profound hearing deficits.

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Long-term facial nerve clinical evaluation following vestibular schwannoma surgery

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000200010 ◽

2008 ◽

Vol 66 (2a) ◽

pp. 194-198 ◽

Cited By ~ 15

Author(s):

Rafaela Julia Batista Veronezi ◽

Yvens Barbosa Fernandes ◽

Guilherme Borges ◽

Ricardo Ramina

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Tumor Size ◽

Nerve Function ◽

Facial Nerve Function ◽

Significant Difference ◽

Long Term Follow Up ◽

Facial Function

BACKGROUND: Facial function is important in accompaniment of patients operated on vestibular schwannoma (VS). OBJETIVE: To evaluate long term facial nerve function in patients undergoing VS resection and to correlate tumor size and facial function in a long-term follow-up. METHOD: Transversal study of 20 patients with VS operated by the retrosigmoid approach. House-Brackmann Scale was used preoperatively, immediately after surgery and in a long-term follow-up. Student t test was applied for statistic analysis. RESULTS: In the immediate postoperative evaluation, 65% of patients presented FP of different grades. Improvement of facial nerve function (at least of one grade) occurred in 53% in the long-term follow-up. There was statistically significant difference in facial nerve outcome in long-term follow-up when tumor size was considered (p<0.05). Conclusion: The majority of patients had improvement of FP in a long-term follow-up and tumor size was detected to be a factor associated with the postoperative prognostic.

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Facial nerve preservation in stereotactic radiosurgery of tumors of the cerebellopontine cistern

Russian journal of neurosurgery ◽

10.17650/1683-3295-2021-23-2-57-65 ◽

2021 ◽

Vol 23 (2) ◽

pp. 57-65

Author(s):

S. R. Ilyalov ◽

K. M. Kvashnin ◽

K. E. Medvedeva ◽

A. A. Baulin ◽

O. G. Lepilina ◽

...

Keyword(s):

Facial Nerve ◽

Tumor Volume ◽

Cranial Nerves ◽

Nerve Function ◽

Facial Nerve Function ◽

Facial Paresis ◽

Previous Surgery ◽

Study Objective ◽

The Mean

Introduction. Surgery has traditionally remained the main treatment for tumors of the cerebellopontine cistern but is associated with high risks of dysfunction of the cranial nerves. Radiosurgery is usually performed both as an adjuvant treatment and as an independent option.The study objective is to assess the safety of routine use of radiosurgery to preserve facial nerve function in the treatment of tumors of different origins located in the cerebellopontine cistern.Materials and methods. Since March 2018 to March 2020 there were 145 patients with tumors of cerebellopontine cistern (CPC) at the Center for High-Precision Radiology. Vestibilar schwannomas were detected in 116 (80 %) patients, in 37 cases - relapses or remains after surgery. The 22 patients had meningiomas, 6 after open surgery (WHO I). Trigeminal schwannomas - in 3 patients, facial schwannomas - in 2, jugular schwannomas - in 1 and metastasis of prostate cancer - in 1. 31 patients had facial paresis of different degrees after previous surgery. Among non-operated patients, facial paresis before radiosurgery was observed in only 1 patient. Radiosurgery was performed using the Leksell Gamma Knife Perfexion, the mean marginal dose was 12.2 Gy (11-15 Gy), the mean tumor volume was 3.98 cm3 (0.06-17.47 cm3).Results. Follow-up was performed in 85 patients. The mean follow-up was 359.3 days (91-776), the median follow-up was 367 days. Reduction of the tumor volume was detected in 27 patients, stabilization of the process in 15. The average decrease was 23.9 % (95 % CI 16.8-31.0 %). Transient postirradiation increase was observed in 30 patients only in the group of schwannomas and mean tumor volume increase was 53.7 % (95 % CI 38.5-68.9 %). In patients with previous surgery there were not cases of decline or regression facial paresis. Among patients who had not been operated on before radiosurgery, only in 1 case was the development of facial paresis (House-Brackman III) 5 months after irradiation, which amounted to 1.8 %. It should be especially noted that facial nerve function remained unchanged (House-Brackman I) in both patients with facial schwannomas. Also, not a single case of hemifacial spasm was identified.Conclusion. Radiosurgery of CPC tumors with a marginal dose from 12 to 15 Gy has a high degree of safety in relation to the facial nerve. This makes it possible to justify radiosurgery as alternative to traditional neurosurgical interventions.

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The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140152 ◽

2014 ◽

Vol 72 (12) ◽

pp. 925-930 ◽

Cited By ~ 1

Author(s):

Eduardo A. S. Vellutini ◽

André Beer-Furlan ◽

Roger S. Brock ◽

Marcos Q. T. Gomes ◽

Aldo Stamm ◽

...

Keyword(s):

Facial Nerve ◽

Cranial Nerves ◽

Microsurgical Anatomy ◽

Nerve Function ◽

Facial Nerve Function ◽

Tumor Removal ◽

Total Resection ◽

Nerve Preservation ◽

One Year

The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.

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Intraoperative transcranial facial motor evoked potential monitoring in surgery of cerebellopontine angle tumors predicts early and late postoperative facial nerve function

Clinical Neurophysiology ◽

10.1016/j.clinph.2020.12.025 ◽

2021 ◽

Vol 132 (4) ◽

pp. 864-871

Author(s):

Ryo Hiruta ◽

Taku Sato ◽

Takeshi Itakura ◽

Masazumi Fujii ◽

Jun Sakuma ◽

...

Keyword(s):

Facial Nerve ◽

Cerebellopontine Angle ◽

Evoked Potential ◽

Motor Evoked Potential ◽

Nerve Function ◽

Facial Nerve Function ◽

Cerebellopontine Angle Tumors ◽

Evoked Potential Monitoring ◽

Potential Monitoring

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

Operative Neurosurgery ◽

10.1093/ons/opab335 ◽

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.

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Long-Term Follow-Up of the Repair of the Multiple-Branch Facial Nerve Defect Using Acellular Nerve Allograft

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2015.08.005 ◽

2016 ◽

Vol 74 (1) ◽

pp. 218.e1-218.e11 ◽

Cited By ~ 4

Author(s):

Min Hu ◽

Hongxi Xiao ◽

Yu Niu ◽

Hongfei Liu ◽

Lihai Zhang

Keyword(s):

Facial Nerve ◽

Long Term Follow Up ◽

Acellular Nerve Allograft

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Sporadic unilateral vestibular schwannoma in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.3.peds08434 ◽

2009 ◽

Vol 4 (2) ◽

pp. 125-129 ◽

Cited By ~ 8

Author(s):

Brian P. Walcott ◽

Ganesh Sivarajan ◽

Bronislava Bashinskaya ◽

Douglas E. Anderson ◽

John P. Leonetti ◽

...

Keyword(s):

Facial Nerve ◽

Tumor Size ◽

Pediatric Population ◽

Neurofibromatosis Type ◽

Neurofibromatosis Type 2 ◽

Nerve Function ◽

Facial Nerve Function ◽

Duration Of Symptoms

Object Vestibular schwannomas (VSs) are rare in the pediatric population. Most often, these lesions manifest as a bilateral disease process in the setting of neurofibromatosis Type 2. Even in the absence of additional clinical diagnostic criteria, the presentation of a unilateral VS in a young patient may be a harbinger of future penetrance for this hereditary tumor syndrome. Methods The authors retrospectively reviewed the charts of a cohort of 7 patients who presented with apparently sporadic, unilateral VSs. These patients had previously undergone surgery via translabyrinthine, retrosigmoid, or combined approaches. Clinical outcomes were reviewed with emphasis on facial nerve function and follow-up for signs and symptoms of a heritable disorder. Results All patients underwent microsurgical resection in a multidisciplinary effort by the senior authors. The average tumor size was 4.57 cm, with an average duration of symptoms prior to definitive diagnosis of 31.2 months. The tumor size at the time of presentation followed a trend different from reports in adults, while the duration of symptoms did not. At a follow-up average of 6.3 years (range 1–12 years), 100% of patients demonstrated good facial function (House-Brackmann Grade I or II). No patient in this cohort demonstrated symptoms, objective signs, or genetic analysis indicating the presence of neurofibromatosis Type 2. Conclusions Diagnosis and management of sporadic, unilateral VSs in children is complicated by clinical presentations and surgical challenges unique from their adult counterparts. Careful consideration should be given to a heritable genetic basis for sporadic unilateral VS in the pediatric population. Results of genetic testing do not preclude the necessity for long-term follow-up and systemic investigation. In patients who present with large tumors, preliminary experience leads the authors to suggest that a combined retrosigmoid-translabyrinthine approach offers the greatest opportunity for preservation of facial nerve function.

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Long-term follow-up report on cross-facial nerve grafting in the treatment of facial paralysis

British Journal of Plastic Surgery ◽

10.1016/0007-1226(83)90009-7 ◽

1983 ◽

Vol 36 (1) ◽

pp. 48-50 ◽

Cited By ~ 7

Author(s):

Alain Gary-Bobo ◽

Jean Marc Fuentes

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Nerve Grafting ◽

Long Term Follow Up

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Schwannomas

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0022 ◽

2019 ◽

pp. 255-270

Author(s):

Tiit Mathiesen ◽

Petter Förander ◽

David Pettersson

Keyword(s):

Facial Nerve ◽

Cranial Nerve ◽

Cerebellopontine Angle ◽

Treatment Options ◽

Life Quality ◽

Intracranial Tumours ◽

Tumour Control ◽

Nerve Paresis

Sporadic vestibular schwannoma (VS) is the commonest tumour of the cerebellopontine angle and comprise 6–8% of all intracranial tumours. The incidence varies between 12 and 20 cases per million inhabitants and years in different reports; a large minority of these tumours grow during follow-up. Treatment options include wait and scan, microsurgery, radiosurgery, and radiotherapy. Micro- and radiosurgery are well validated to offer long-term tumour control, but patients may suffer from hearing deficit and facial nerve paresis. Unexpectedly, long-term life quality is more affected by vertigo and headaches. Other cranial nerve schwannomas cause symptoms depending on the affected nerves and respond to the same therapies when treatment is indicated.

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