Surgery for vestibular schwannomas: a systematic review of complications by approach

2012 ◽  
Vol 33 (3) ◽  
pp. E14 ◽  
Author(s):  
Shaheryar F. Ansari ◽  
Colin Terry ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Residual Tumor ◽  
Middle Cranial Fossa ◽  
Retrosigmoid Approach ◽  
Csf Leak ◽  
Middle Cranial Fossa Approach ◽  
Translabyrinthine Approach ◽  
Cranial Fossa ◽  
Nerve Dysfunction

Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

Diagnosis and treatment of cavernous hemangioma of the internal auditory canal

2016 ◽  
Vol 124 (3) ◽  
pp. 639-646 ◽  
Author(s):  
Wei Dong Zhu ◽  
Qi Huang ◽  
Xi Ye Li ◽  
Hong Sai Chen ◽  
Zhao Yan Wang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Cavernous Hemangioma ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Middle Cranial Fossa ◽  
Surgical Removal ◽  
Translabyrinthine Approach ◽  
History Of ◽  
Cranial Fossa

OBJECT Cavernous hemangioma of the internal auditory canal (IAC) is an extremely rare type of tumor, and only 50 cases have been reported in the literature prior to this study. The aim in this study was to describe the symptomatology, radiological features, and surgical outcomes for patients with cavernous hemangioma of the IAC and to discuss the diagnostic criteria and treatment strategy for the disease. METHODS The study included 6 patients with cavernous hemangioma of the IAC. All patients presented with sensorineural hearing loss and tinnitus, and 2 also suffered from vertigo. Five patients reported a history of facial symptoms with hemispasm or palsy: 3 had progressive facial weakness, 1 had a hemispasm, and 1 had a history of recovery from sudden facial paresis. All patients underwent CT and MRI to rule out intracanalicular vestibular schwannomas and facial nerve neuromas. Five patients had their tumors surgically removed, while 1 patient, who did not have facial problems, was followed up with a wait-and-scan approach. RESULTS All patients had a presurgical diagnosis of cavernous hemangioma of the IAC, which was confirmed pathologically in the 5 patients who underwent surgical removal of the tumor. The translabyrinthine approach was used to remove the tumor in 4 patients, while the middle cranial fossa approach was used in the 1 patient who still had functional hearing. Tumors adhered to cranial nerves VII and/or VIII and were difficult to dissect from nerve sheaths during surgeries. Complete hearing loss occurred in all 5 patients. In 3 patients, the facial nerve could not be separated from the tumor, and primary end-to-end anastomosis was performed. Intact facial nerve preservation was achieved in 2 patients. Patients were followed up for at least 1 year after treatment, and MRI showed no evidence of tumor regrowth. All patients experienced some level of recovery in facial nerve function. CONCLUSIONS Cavernous hemangioma of the IAC can be diagnosed preoperatively through analysis of clinical features and neuroimaging. Early surgical intervention may preserve the functional integrity of the facial nerve and provide a better outcome after nerve reconstruction. However, preservation of functional hearing may not be achieved, even with the retrosigmoid or middle cranial fossa approaches. The translabyrinthine approach seems to be the most appropriate approach overall, as the facial nerve can be easily located and reconstructed.

Bilateral traumatic facial paralysis associated with unilateral abducens palsy: a case report

2005 ◽  
Vol 119 (2) ◽  
pp. 144-147 ◽  
Author(s):  
Tuncay Ulug ◽  
S Arif Ulubil
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Motor Vehicle ◽  
Bone Fractures ◽  
Middle Cranial Fossa ◽  
Geniculate Ganglion ◽  
Abducens Palsy ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa ◽  
The Right

Bilateral traumatic facial paralysis is a very rare clinical condition. Abducens palsy, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 24-year-old male, who developed immediate bilateral facial and right abducens paralyses following a motor vehicle accident, is presented. The patient was referred for neurotologic evaluation 22 days after the injury. Electroneurography (ENoG) demonstrated 100 per cent degeneration at the first examination and, correspondingly, electromyography showed no regeneration potentials. Using high-resolution computed tomography (HRCT), a longitudinal fracture on the right and a mixed-type fracture on the left were identified. The patient had good cochlear reserve on both sides. The decision for surgery was based not on ENoG, because of the delayed referral of the patient, but on the HRCT, which showed clear fracture lines on both sides. The middle cranial fossa approach for decompression of the right facial nerve was performed on the 55th day following the trauma, and a combined procedure using the middle cranial fossa and transmastoid approaches was applied for decompression of the left facial nerve on the 75th day following the trauma. On the right, there was dense fibrosis surrounding the geniculate ganglion and the proximal tympanic segment whereas, on the left, bone fragments impinging on the geniculate ganglion, dense fibrosis surrounding the geniculate ganglion, and a less extensive fibrotic tissue surrounding the pyramidal segment were encountered. There were no complications or hearing deterioration. At the one-year follow up, the patient had House-Brackmann (HB) grade 1 recovery on the right, and HB grade 2 recovery on the left side, and the abducens palsy regressed spontaneously. The middle cranial fossa approach and its combinations can be performed safely in bilateral temporal bone fractures as labyrinthine sparing procedures if done on separate occasions.

Petrosquamosal Suture and Lamina

1981 ◽  
Vol 89 (3) ◽  
pp. 482-495 ◽  
Author(s):  
Bruce Proctor ◽  
Eric Nielsen ◽  
Conrad Proctor
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Nerve Injury ◽  
Middle Ear ◽  
Middle Cranial Fossa ◽  
Facial Nerve Injury ◽  
Cranial Fossa ◽  
Middle Ear Cleft

The junction of the petrosal and squamosal portions of the temporal bone has important relationships that are of interest to the otologist. The resultant suture extends from the glaserian fissure across the top of the middle ear cleft and into the mastoid portion of the temporal bone. It may permit quick passage of infection from the middle ear to the middle cranial fossa. The petrosa may override the squama, forcing it down into the tympanum, where it could cause malleus fixation and a conductive type hearing loss. In the mastoid the suture is identifiable on the surface, but in the interior it is represented by the petrosquamosal lamina. The deeper portion in the petrosal portion of the mastoid may be easily overlooked in surgery of the mastoid and may lead to facial nerve injury.

Facial nerve neuroma mimicking chronic otitis

2020 ◽  
Vol 9 (2) ◽  
pp. 58-61
Author(s):  
Klaudyna Zwierzyńska ◽  
Robert Bartoszewicz ◽  
Kazimierz Niemczyk
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Chronic Otitis Media ◽  
Middle Cranial Fossa ◽  
Middle Fossa Approach ◽  
Mixed Hearing Loss ◽  
Cranial Fossa ◽  
Retroauricular Approach ◽  
Inflammatory Changes ◽  
Methods Of Treatment

A 44-year-old male presented with a facial schwannoma extending into both the middle cranial fossa and mastoid processus. Due to hearing loss, facial nerve palsy and inflammatory changes in CT scan, this patient was misdiagnosed as chronic otitis media. Audiogram showed a right mixed hearing loss with 30–40 dB air-bone gap. In MR, features of the facial nerve neuroma were found. The patient was qualified for surgery to remove the tumor via middle fossa approach, with possible conversion to the retroauricular approach. Ossiculoplasty LC was performed. Diagnostic problems and methods of treatment are discussed.

Outcomes of Transzygomatic Middle Cranial Fossa Approach for Skull Base Tumors—A Single Institutional Experience

2020 ◽  
Author(s):  
Nauman F. Manzoor ◽  
Peter Morone ◽  
Patrick D. Kelly ◽  
Silky Chotai ◽  
Robert J. Yawn ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Middle Cranial Fossa ◽  
Csf Leak ◽  
Tumor Control ◽  
Skull Base Tumors ◽  
Total Resection ◽  
Neurological Morbidity ◽  
Cranial Fossa ◽  
The Mean

Abstract Objectives To evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting This study was done at the tertiary skull base center. Design This is a retrospective case series. Main Outcome Measures The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications. Results Sixteen patients were identified with a median age of 45 years (range: 20–72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1–7.3) and the mean tumor volume was 28.5 cm3 (SD: 18.8, range: 2.9–63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma (n = 7) followed by chondrosarcoma (n = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V (n = 1), CN III (n = 2), CN VI (n = 1), and CN X (n = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House–Brackmann grade 2). Conclusion Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity.

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