Intraoperative Monitoring of Facial Nerve Evoked Electromyography during Surgery for Cerebellopontine Angle Tumors

AbstractConcurrent occurrence of brain tumors in the same location is very unusual and has been noted in patients with neurofibromatosis. Two lesions, occurring in close contact but of different histology, are called contiguous tumors. Schwannoma and meningioma are the two common histologies reported to present as contiguous tumor. We present two patients with contiguous tumors in the cerebellopontine angle. The magnetic resonance imaging characteristics in both cases demonstrate important findings that should be identified to raise the possibility of contiguous tumors. We discuss the surgical implications in identifying the facial nerve in this complex tumor morphology and steps we took to preserve function. Variable displacement of the facial nerve in the presence of multiple tumors needs to be kept in mind during surgical management and can be significantly aided by intraoperative monitoring.

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Intraoperative Monitoring and Facial Nerve Outcomes in Cerebellopontine Angle (CPA) Surgery

Otology & Neurotology ◽

10.1097/00129492-200200001-00034 ◽

2002 ◽

Vol 23 (Sup 1) ◽

pp. S12

Author(s):

Brandon Isaacson ◽

Hussam El-Kashlan ◽

Paul Kileny

Keyword(s):

Facial Nerve ◽

Intraoperative Monitoring ◽

Cerebellopontine Angle

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Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors

Journal of Neurosurgery ◽

10.3171/jns.1992.77.5.0724 ◽

1992 ◽

Vol 77 (5) ◽

pp. 724-731 ◽

Cited By ~ 58

Author(s):

Luis F. Pitty ◽

Charles H. Tator

Keyword(s):

Facial Nerve ◽

Facial Palsy ◽

Cerebellopontine Angle ◽

Surgical Techniques ◽

Content Type ◽

Factors Affecting ◽

Cerebellopontine Angle Tumors ◽

Nerve Anastomosis ◽

Fair Poor ◽

Fine Print

✓ Hypoglossal-facial nerve anastomosis is one of the procedures frequently performed to restore function after facial palsy secondary to surgery for removal of cerebellopontine angle tumors. The published results of hypoglossal-facial nerve anastomosis have been variable, and there are still questions about the indications, timing, and surgical techniques for this procedure. The goals of the present retrospective analysis of 22 cases of hypoglossal-facial nerve anastomosis were to assess the extent of the functional recovery and to analyze the factors affecting this recovery. The 22 cases of complete facial palsy were gleaned from a series of 245 cases of cerebellopontine angle tumors treated surgically by one of the authors. Twenty patients had an acoustic neuroma (average size 3.5 cm), one patient had a petrous meningioma, and one patient had a facial neuroma. The average age of the patients was 47.3 years (range 19 to 69 years). The average interval from tumor surgery to hypoglossal-facial nerve anastomosis was 6.4 months (range 12 days to 17 months), and the average follow-up period after the procedure was 65 months. The results were graded as good, fair, poor, or failure according to a new method of classifying facial nerve function after hypoglossal-facial nerve anastomosis. The results were good in 14 cases (63.6%), fair in three (13.6%), and poor in four (18.2%); one (4.5%) was a failure. Good and fair results occurred with higher frequency in younger patients who were operated on within shorter intervals, although these relationships were not statistically significant. There were no surgical complications. Good or fair results were achieved in 17 (77.3%) of the 22 cases, and thus hypoglossal-facial nerve anastomosis is considered an effective procedure for most patients with facial palsy after surgery for cerebellopontine angle tumors.

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Rekonstruktivna hirurgija povreda facijalisa

Acta chirurgica iugoslavica ◽

10.2298/aci0301063b ◽

2003 ◽

Vol 50 (1) ◽

pp. 63-67

Author(s):

Vladimir Bascarevic ◽

Miroslav Samardzic ◽

Lukas Rasulic ◽

Vesna Simic

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Surgical Procedures ◽

Functional Recovery ◽

Cerebellopontine Angle ◽

Motor Nerve ◽

Nerve Grafting ◽

Cerebellopontine Angle Tumors ◽

The Face ◽

Nerve Anastomosis

The facial nerve is main motor nerve of the face and its injury leads to total ipsilateral paralysis. There are several surgical procedures in reconstruction of the facial nerve, and the most frequent one is hypoglosso-facial anastomosis. In this study were analysed a series of 69 patients operated on Institute of neurosurgery from 1981 to 2000 year. The most frequent cause of injury was the operation of cerebellopontine angle tumors, as well as the skull base fractures. Hypoglosso-facial anastomosis was done in 57 patients, in 5 cases we performed nerve grafting in the cerebellopontine angle, and in 7 patients the facial nerve was operated peripherally. Results were analyzed in 27 of 57 patients with hipoglosso-facial nerve anastomosis. Functional recovery was achived in 22 (81,4%) patients.

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