Facial Nerve Function After Vestibular Schwannoma Surgery Following Failed Conservative Management

Abstract BACKGROUND: Because only a limited proportion of vestibular schwannomas display growth after diagnosis, an increasing number of patients are managed conservatively. Tumor growth during “wait and scan” may, however, necessitate surgery. In these cases, increased tumor size is likely to increase the risk of impaired facial nerve function after surgery. OBJECTIVE: To compare facial nerve function in patients operated on soon after diagnosis with patients allocated to conservative management and the subgroup of these who later had surgery because of tumor growth. METHODS: A total of 1378 consecutive patients diagnosed with a vestibular schwannoma 20 mm extrameatal or smaller were included; 419 patients were operated on soon after diagnosis, and 959 patients were initially managed conservatively. In the latter group, 161 patients were subsequently operated on owing to tumor growth. RESULTS: All conservatively managed patients had normal facial nerve function at the end of observation. Good facial nerve outcome was found in 87% of patients operated on at diagnosis and in 84% of patients operated on after established tumor growth. For the subgroup of small extrameatal tumors, this difference was significant. When all patients allocated primarily to conservative management were pooled, good facial function was found in 97%, which was significantly better than the result for primary operation (87%). CONCLUSION: Overall, conservative management of small to medium-sized vestibular schwannomas is the best option in terms of preservation of facial nerve function. Tumor growth during observation is found in only a minor proportion of the patients, and in these cases, surgery or irradiation should be performed immediately.

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Pre-operative and per-operative factors conditioning long-term facial nerve function in vestibular schwannoma surgery through translabyrinthine approach

The Journal of Laryngology & Otology ◽

10.1017/s0022215100140733 ◽

1998 ◽

Vol 112 (5) ◽

pp. 441-445 ◽

Cited By ~ 15

Author(s):

Olivier Deguine ◽

André Maillard ◽

Alain Bonafe ◽

Hassan El Adouli ◽

Michel Tremoulet ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Internal Auditory Canal ◽

Stage Iv ◽

Nerve Function ◽

Facial Nerve Function ◽

Stimulation Threshold ◽

Translabyrinthine Approach ◽

Facial Function

AbstractFacial nerve function was evaluated in 103 patients, after vestibular schwannoma removal through the translabyrinthine approach. The mean follow-up was 43 months (minimum six months). Grade I facial function was achieved in 100 per cent of stage I schwannomata compared with 36 per cent of stage IV schwannomata. Grade I or II facial function was found in 78 per cent of homogeneous schwannomata, compared with 48 per cent of heterogeneous schwannomata. Facial function was preserved in 89 per cent of cases, if the angle between the internal auditory canal and the schwannoma was >66°, compared with 54 per cent if the angle was <66°. There was 82 per cent of normal facial function when the nerve appeared normal after tumour removal, compared with 18 per cent when the nerve was traumatized. When the ratio (stimulation threshold at the internal auditory canal/stimulation threshold at brainstem) was <2, postoperative facial function was preserved in 87 per cent of cases, compared with 13 per cent when the ratio was >2.

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Macrophage Density Predicts Facial Nerve Outcome and Tumor Growth after Subtotal Resection of Vestibular Schwannoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1627474 ◽

2018 ◽

Vol 79 (05) ◽

pp. 482-488

Author(s):

Christopher Graffeo ◽

Avital Perry ◽

Aditya Raghunathan ◽

Trynda Kroneman ◽

Mark Jentoft ◽

...

Keyword(s):

Tumor Growth ◽

Facial Nerve ◽

Tumor Progression ◽

Vestibular Schwannoma ◽

Subtotal Resection ◽

Nerve Function ◽

Facial Nerve Function ◽

Macrophage Density ◽

Primary Endpoints ◽

Percent Positivity

Introduction Vestibular schwannoma (VS) behavior following subtotal resection (STR) is highly variable. Overall progression rates have been reported as high as 44%, and optimal treatment is controversial. Correspondingly, identification of a reliable clinical or pathologic marker associated with progression after STR would help guide decision-making. Methods A prospectively maintained institutional VS registry from 1999 to 2014 was retrospectively reviewed for sporadic VS patients who underwent primary STR without preceding stereotactic radiosurgery (SRS) by a single neurosurgery-neurotology team. Primary endpoints included tumor progression and postoperative facial nerve function. Pathologic specimens were stained for Ki67, CD68, S100, and SOX10 and were quantitated by digital imaging analysis. Macrophage density was defined as the ratio of CD68+ macrophages to S100+ macrophages and Schwannian tumor cells. Clinical outcomes were correlated with pathologic markers. Results Forty-six patients met the study inclusion criteria. Thirteen (28%) progressed during a mean 57 months of follow-up (range 15–149). Favorable postoperative facial nerve function (House–Brackmann I–II) was achieved in 37 (80%). CD68+ cells were present at significantly higher concentrations in tumors that progressed (p = 0.03). Higher macrophage density was significantly associated with both tumor progression (p = 0.02) and unfavorable facial nerve function (p = 0.02). Ki67 percent positivity was not significantly associated with either primary endpoint (p = 0.83; p = 0.58). Conclusions Macrophage density may provide an important marker for individuals at the highest risk for progression of VS after STR, potentially prompting closer surveillance or consideration for upfront SRS following STR. This finding supports preceding conclusions that an intratumoral macrophage-predominant inflammatory response may be a marker for tumor growth and a potential therapeutic target.

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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 Function after Vestibular Schwannoma Surgery Following Failed Conservative Management

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1314178 ◽

2012 ◽

Vol 73 (S 02) ◽

Author(s):

P. Caye-Thomasen ◽

M. Kaltoft ◽

S.-E. Stangerup

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Conservative Management ◽

Nerve Function ◽

Facial Nerve Function

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Late-onset facial nerve degeneration after vestibular schwannoma surgery: incidence, putative mechanisms, and prevention

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.3.11 ◽

1998 ◽

Vol 5 (3) ◽

pp. E10 ◽

Cited By ~ 5

Author(s):

Prakash Sampath ◽

Laurence D. Rhines ◽

Michael J. Holliday ◽

Henry Brem ◽

Donlin M. Long

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Late Onset ◽

Treatment Strategies ◽

Rare Condition ◽

Nerve Degeneration ◽

Nerve Function ◽

Facial Nerve Function ◽

Significant Deterioration ◽

Facial Function

Delayed facial nerve dysfunction after vestibular schwannoma surgery is a poorly understood phenomenon that has been reported to occur in 15 to 29% of patients undergoing microsurgery. It is a condition characterized by spontaneous deterioration of facial nerve function in a patient who has otherwise normal or near-normal facial function in the immediate postoperative period. This delayed paralysis is generally reported to occur in the first few days postsurgery, with the majority of patients eventually recovering their immediate postoperative facial function. However, infrequently, it can also occur more than 1 week after surgery (so-called late-onset facial nerve palsy). The authors reviewed facial nerve outcome in 611 patients who underwent microsurgery between 1973 and 1994. The facial nerve was anatomically preserved in 596 patients (97.5%), and 90% of patients had House-Brackmann[6] Grade 1 or 2 function 1 year after surgery. Late-onset facial dysfunction was seen in 13 patients (2.1%). All of these had significant deterioration in facial nerve function between 1 and 4 weeks postoperatively, and all showed improvement by 1 year. In this study, the focus on these patients who developed late-onset facial palsy. The incidence, treatment strategies, and outcomes will be discussed with emphasis on possible pathophysiological mechanisms that contribute to this relatively rare condition.

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