Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

2016 ◽  
Vol 124 (3) ◽  
pp. 657-664 ◽  
Author(s):  
Christian Scheller ◽  
Andreas Wienke ◽  
Marcos Tatagiba ◽  
Alireza Gharabaghi ◽  
Kristofer F. Ramina ◽  
...  
Keyword(s):  
Treatment Group ◽  
Facial Nerve ◽  
Hydroxyethyl Starch ◽  
Phase Iii ◽  
Control Group ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Phase Iii Trial ◽  
Nerve Preservation ◽  
Multicenter Phase

OBJECT A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. METHODS An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1–2 mg/hr) and hydroxyethyl starch (hematocrit 30%–35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. RESULTS Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [67.3%] of 52 [treatment group] compared with 34 [72.3%] of 47 [control group]) (p = 0.745) or hearing preservation (11 [23.4%] of 47 [treatment group] compared with 15 [31.2%] of 48 [control group]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups (OR 1.07 [95% CI 0.34–3.43], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18–1.30], p = 0.15). Apart from dose-dependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed. CONCLUSIONS There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.

scholarly journals The Offprint of an Abnormal Pre-Parotidectomy Electrodiagnostic Finding in a Normally Functioning Facial Nerve: Correlation with Intraoperative Findings, Histology and Postoperative Facial Nerve Function

2022 ◽  
Vol 11 (1) ◽  
pp. 248
Author(s):  
Verena Katheder ◽  
Matti Sievert ◽  
Sarina Katrin Müller ◽  
Vivian Thimsen ◽  
Antoniu-Oreste Gostian ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Malignant Tumor ◽  
Facial Palsy ◽  
Benign Lesion ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Clinically Normal ◽  
Parotid Tumors ◽  
Supramaximal Stimulation

The aim of this study was to search for associations between an electrodiagnostically abnormal but clinically normal facial nerve before parotidectomy and the intraoperative findings, as well as the postoperative facial nerve function. The records of all patients treated for parotid tumors between 2002 and 2021 with a preoperative House–Brackmann score of grade I but an abnormal electrophysiologic finding were studied retrospectively. A total of 285 patients were included in this study, and 222 patients had a benign lesion (77.9%), whereas 63 cases had a malignant tumor (22.1%). Electroneurographic facial nerve involvement was associated with nerve displacement in 185 cases (64.9%) and infiltration in 17 cases (6%). In 83 cases (29.1%), no tumor–nerve interface could be detected intraoperatively. An electroneurographic signal was absent despite supramaximal stimulation in 6/17 cases with nerve infiltration and in 17/268 cases without nerve infiltration (p < 0.001). The electrophysiologic involvement of a normal facial nerve is not pathognomonic for a malignancy (22%), but it presents a rather rare (~6%) sign of a “true” nerve infiltration and could also appear in tumors without any contact with the facial nerve (~29%). Of our cases, two thirds of those with an anatomic nerve preservation and facial palsy had already directly and postoperatively recovered to a major extent in the midterm.

scholarly journals Retrosigmoid Transmeatal Approach for Resection of Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S269-S270
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Protective Layer ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Nerve Preservation ◽  
Tumor Capsule ◽  
Acoustic Neuromas ◽  
Dissection Technique

The retrosigmoid (suboccipital) approach is the workhorse for most acoustic neuromas in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate the nuances of the subperineural dissection technique for microsurgical resection of an acoustic neuroma via the retrosigmoid transmeatal approach. The plane is developed by separating the perineurium of the vestibular nerve away from the tumor capsule. This perineurium provides a protective layer between the tumor capsule and the facial nerve which serves as a buffer to avoid direct dissection and potential trauma to the facial nerve. Using this technique during extracapsular tumor dissection helps to maximize the extent of tumor removal while preserving facial nerve function. A gross total resection of the tumor was achieved, and the patient exhibited normal facial nerve function (Fig. 1). In summary, the retrosigmoid transmeatal approach with the use of subperineural dissection are important strategies in the armamentarium for surgical management of acoustic neuromas with the goal of maximizing tumor removal and preserving facial nerve function (Fig. 2).The link to the video can be found at: https://youtu.be/L3lPtSvJt60.

scholarly journals Translabyrinthine Approach for Resection of Large Cystic Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S267-S268
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Extracapsular Dissection ◽  
Cerebellar Retraction

The translabyrinthine approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a translabyrinthine approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the translabyrinthine approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function.The link to the video can be found at: https://youtu.be/zld2cSP8fb8.

Preservation of Facial Nerve Function after Postoperative Vasoactive Treatment in Vestibular Schwannoma Surgery

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 577-584 ◽  
Author(s):  
Christian Strauss ◽  
Johann Romstöck ◽  
Rudolf Fahlbusch ◽  
Stefan Rampp ◽  
Christian Scheller
Keyword(s):  
Facial Nerve ◽  
Hydroxyethyl Starch ◽  
Vestibular Schwannoma ◽  
Complete Recovery ◽  
Potential Effect ◽  
Long Term Results ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Before And After

Abstract OBJECTIVE: Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experimental and clinical studies point to a beneficial effect of nimodipine and hydroxyethyl starch for preservation of cochlear nerve function. A retrospective analysis was undertaken to evaluate the effect of vasoactive treatment on facial nerve outcome. PATIENTS AND METHODS: Forty-five patients with vestibular schwannoma removal, intraoperative electromyographic monitoring, and postoperative deterioration of facial nerve function were evaluated. Twenty-five patients underwent vasoactive treatment consisting of nimodipine and hydroxyethyl starch for improvement of hearing outcome. Twenty patients did not receive such treatment. Facial nerve function was evaluated before and after surgery, as well as 1 year after the surgical procedure. Patients were comparable regarding age, tumor size, and preoperative facial nerve function. RESULTS: Long-term results of facial nerve function were significantly improved in those patients who experienced severe postoperative deterioration of facial nerve function and received vasoactive treatment as compared with patients who did not receive nimodipine and hydroxyethyl starch after surgery. Treated patients showed a significantly higher rate of complete recovery compared with patients without treatment. CONCLUSION: The study points to a potential effect of vasoactive treatment for facial nerve function after vestibular schwannoma surgery. In particular, patients with postoperative disfiguring facial nerve palsy clearly benefit from intravenous hydroxyethyl starch and nimodipine with respect to a long-term socially acceptable facial nerve function.

scholarly journals Extra-Arachnoidal Dissection for Excision of Giant Vestibular Schwannomas: Improved Facial Nerve Preservation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sunil K Gupta
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Total Excision ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract INTRODUCTION Surgical excision of giant vestibular schwannomas with preservation of facial nerve function remains a challenge. A modified surgical technique using an extra-arachnoid plane of dissection and limited meatal drilling is described here with the goal of improving the rated of functional preservation of facial nerve. METHODS The clinical material was analyzed for two groups: Group A patients of giant vestibular schwannomas operated between 2002 and 2009 with the “standard” surgical technique, Group B- patients of giant vestibular schwannomas operated between 2009 and 2015 using the new technique of pure extra-arachnoid dissection and limited meatal drilling. RESULTS Group A: Of the 115 patients in this group, total excision was possible in 103 (89.5%), near total excision in 7 (6%) and partial excision in 5 (4.3%) patients. Anatomical preservation of 7th nerve was achieved in 87.8% of patients. House and Brackman grade 1 and grade 2 facial nerve function was present in 68 (59.1%) patients, grade 3 in 10 (8.7%), grades 4 and 5 in 11 (9.6%), and 26 (22.6%) had grade 6 facial nerve involvement. Group B: Of the 127 patients operated by this technique, details and long term follow-up was available for 98 patients. Total excision was achieved in 70 (71.4%) patients, near total excision in 9 (9.2%), and subtotal excision in 19 (19.4%) cases. Four patients had repeat surgery and 14 patients underwent gamma knife radiosurgery. At follow-up, 78 (79.5%) patients had grade 1 and 2 facial nerve involvement, while 20 (20.4%) patients continued to have a poor function (grade 3-5). CONCLUSION Extra-arachnoid dissection and limited meatal drilling resulted in an improved rate of functional facial nerve preservation.

Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients

2006 ◽  
Vol 105 (4) ◽  
pp. 527-535 ◽  
Author(s):  
Madjid Samii ◽  
Venelin Gerganov ◽  
Amir Samii
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Neurological Status ◽  
Retrosigmoid Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Permanent Morbidity

Object The aim of this study was to evaluate and present the results of current surgical treatment of vestibular schwannomas (VSs) and to report the refinements in the operative technique. Methods The authors performed a retrospective study of 200 consecutive patients who had undergone VS surgery over a 3-year period. Patient records, operative reports, follow-up data, and neuroradiological findings were analyzed. The main outcome measures were magnetic resonance imaging, neurological status, patient complaints, and surgical complications. Complete tumor removal was achieved in 98% of patients. Anatomical preservation of the facial nerve was possible in 98.5% of patients. In patients treated for tumors with extension Classes T1, T2, and T3, the rate of facial nerve preservation was 100%. By the last follow-up examination, excellent or good facial nerve function had been achieved in 81% of the cases. By at least 1 year postsurgery, no patients had total facial palsy. In the patients with preserved hearing, the rate of anatomical preservation of the cochlear nerve was 84%. The overall rate of functional hearing preservation was 51%. There was no surgery-related permanent morbidity in this series of patients. Cerebrospinal fluid leakage was diagnosed in 2% of the patients. The mortality rate was 0%. Conclusions The goal of VS treatment should be total removal in one stage and preservation of neurological function, as they determine a patient’s quality of life. This goal can be safely and successfully achieved using the retrosigmoid approach.

scholarly journals Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

2017 ◽  
Vol 127 (6) ◽  
pp. 1231-1241 ◽  
Author(s):  
Randy S. D'Amico ◽  
Matei A. Banu ◽  
Petros Petridis ◽  
Alexandra S. Bercow ◽  
Hani Malone ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Extent Of Resection ◽  
Nerve Sparing ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Anatomical Features ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Tumor Origin ◽  
Microsurgical Resection

OBJECTIVEAdvanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC).METHODSMedical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve–sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated.RESULTSAccording to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes.CONCLUSIONSCPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass effect or acute neurological symptoms. Maximal safe resection with preservation of neurological function can be performed for tumors 2.5 cm or larger without significant risk of facial nerve dysfunction, and, when combined with GKRS for recurrence and/or progression, provides excellent disease control. Anatomical features of the tumor origin offer critical insights for optimizing facial nerve preservation in this cohort.

scholarly journals Retrosigmoid approach for giant cystic vestibular schwannoma: subperineural dissection technique for facial nerve preservation

2021 ◽  
Vol 5 (2) ◽  
pp. V7
Author(s):  
Ali Tayebi Meybodi ◽  
Robert W. Jyung ◽  
James K. Liu
Keyword(s):  
Facial Nerve ◽  
Thin Layer ◽  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Retrosigmoid Approach ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Nerve Preservation ◽  
Dissection Technique

In this illustrative video, the authors demonstrate retrosigmoid resection of a giant cystic vestibular schwannoma using the subperineural dissection technique to preserve facial nerve function. This thin layer of perineurium arising from the vestibular nerves is used as a protective buffer to shield the facial and cochlear nerves from direct microdissection trauma. A near-total resection was achieved, and the patient had an immediate postoperative House-Brackmann grade I facial nerve function. The operative nuances and pearls of technique for safe cranial nerve and brainstem dissection, as well as the intraoperative decision and technique to leave the least amount of residual adherent tumor, are demonstrated. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21128

scholarly journals Evaluation of the effectiveness of the use of functional electrical stimulation after VII-XII anastomosis in patients with facial nerve damage of various etiologies

2019 ◽  
pp. 21-27
Author(s):  
Andrej Bobrov ◽  
Oleg Borisenko ◽  
Volodimir Jus ◽  
Alexander Papp
Keyword(s):  
Electrical Stimulation ◽  
Surgical Treatment ◽  
Facial Nerve ◽  
Postoperative Period ◽  
Nerve Fibers ◽  
Main Group ◽  
Control Group ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Facial Muscles

Surgical treatment of lesions of the facial nerve by an hypoglossal-facial anastomosis takes a long time to re-sprout of the nerve fibers to the facial muscles. The recovery time of facial function after surgical treatment of patients with paralysis of the facial nerve is long enough and can start from 6-8 months after surgery and last up to 2 years. Thus, all this time the mimic muscles are in a state of denervation. The purpose of this work was to determine the effect of electrical stimulation of facial muscles in patients with lesions of the facial nerve of different etiology after hypoglossal -facial anastomosis. Materials and methods: To evaluate the results of the use of early postoperative transcutaneus electrical stimulation, a low frequency FES was used, starting from the 2nd month after performing a XII-VII anastomosis. Assessment of the recovery of facial nerve function was performed 1 year after surgery. The study included 88 patients who underwent surgery to restore facial nerve function - hypoglossal -facial anastomosis. The survey was divided into 2 groups. The first (main) group consisted of 28 patients who underwent FES of facial muscles in the postoperative period, and the second group (comparison) consisted of 60 patients who underwent XII-VII anastomosis according to the following by the same method, but no further pharmacological or physiotherapeutic agents were used that could affect facial nerve regeneration. Results and discussion: According to this scale, the surveyed control group after 12 months. After the operation of XII-VII anastomosis according to the classical method, the following distribution was observed: The 1st degree of recovery of facial nerve function was not present in any of the patients, the 2nd degree had 2 (3.33%) patients, the thirds - 28 (46, 66%), IV - 20 (33,33%), V - 6 (10%) and VI - 4 (6,66%). In patients in the main group (where FES was used), distribution by degrees of recovery of facial nerve function on the House-Brackman scale after 12 months. after surgery it had the following character: II degree had 2 (6.45%) examined, III - 17 (54.83%), IV - 5 (22.58%), V - 2 (7.4%) and VI - 2 (7.4%). Conclusions: A statistically significant difference was observed in the postoperative period when comparing the mean M-responses of mimic muscles registered at different times after surgery in control subjects compared with patients in the main group in which FES was used. In addition, in the main group, a significantly larger number of patients reported a recovery of FN function to grade III-IV on the House-Brackman scale. Therefore, based on the results of the evaluation of the function of FN on the House-Brackman scale and electromyographic examination data in patients who underwent XII-VII anastomosis, it can be argued that with the use of FES in the postoperative period of recovery of facial nerve function is significantly faster and more complete in compared to the control group.

scholarly journals Effect of Penetration Electroacupuncture Combined with Intermediate Frequency Electrotherapy, Facial Acupoint Massage, and Cervical Reduction on Facial Nerve Function and Curative Effect of Senile Refractory Facial Paralysis

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Xiao-Jun Wang ◽  
Ni-Na He ◽  
Wen-Bin Ji ◽  
Li Yu ◽  
Ping Zhang
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Remission Rate ◽  
Combined Treatment ◽  
Intermediate Frequency ◽  
Control Group ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tcm Syndrome ◽  
Better Than

Objective. This study aimed to explore the curative effects on senile refractory facial paralysis treated by penetration electroacupuncture combined with intermediate frequency electrotherapy, facial acupoint massage, and cervical reduction on facial nerve. Methods. 106 elderly patients with intractable facial paralysis that were retrospectively analyzed were all admitted from January 2019 to June 2020. The 106 patients were evenly divided into 2 groups according to the treatment method. The control group was treated with penetration electroacupuncture, while the observation group was treated with penetration electroacupuncture plus intermediate frequency electrotherapy + facial acupoint massage + cervical reduction treatment. Then, House–Brackmann (H-B) facial nerve function evaluation, RPA score, TCM syndrome score, disease remission rate, and incidence of adverse events were evaluated and compared between the two groups. Results. After 4 weeks of treatment, the H-B facial nerve function grading in the observation group was better than that in the control group ( P  < 0.05). And the disease remission rate after 1 week, 2 weeks, and 4 weeks of treatment was higher than that in the control group ( P  < 0.05). Meanwhile, the TCM syndrome score and RPA score after 2 weeks and 4 weeks of treatment were better than that in the control group ( P  < 0.05). Conclusion. For the elderly patients with refractory facial paralysis, the application of the combined treatment that penetration electroacupuncture + medium frequency electrotherapy + facial acupoint massage + cervical adjustment can significantly improve the facial nerve function and reduce various diseases, and the effect of this combined treatment plan is more significant than that of penetration electroacupuncture treatment.

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