Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas

2018 ◽  
Vol 128 (3) ◽  
pp. 903-910 ◽  
Author(s):  
Daniele Bernardeschi ◽  
Nadya Pyatigorskaya ◽  
Antoine Vanier ◽  
Franck Bielle ◽  
Mustapha Smail ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Facial Nerve ◽  
Residual Tumor ◽  
Incomplete Resection ◽  
Nerve Function ◽  
Inclusion Criteria ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Supramaximal Stimulation ◽  
Stimulation Of

OBJECTIVEIn large vestibular schwannoma (VS) surgery, the facial nerve (FN) is at high risk of injury. Near-total resection has been advocated in the case of difficult facial nerve dissection, but the amount of residual tumor that should be left and when dissection should be stopped remain controversial factors. The objective of this study was to report FN outcome and radiological results in patients undergoing near-total VS resection guided by electromyographic supramaximal stimulation of the FN at the brainstem.METHODSThis study was a retrospective analysis of a prospectively maintained database. Inclusion criteria were surgical treatment of a large VS during 2014, normal preoperative FN function, and an incomplete resection due to the strong adherence of the tumor to the FN and the loss of around 50% of the response of supramaximal stimulation of the proximal FN at 2 mA. Facial nerve function and the amount and evolution of the residual tumor were evaluated by clinical examination and by MRI at a mean of 5 days postoperatively and at 1 year postoperatively.RESULTSTwenty-five patients met the inclusion criteria and were included in the study. Good FN function (Grade I or II) was observed in 16 (64%) and 21 (84%) of the 25 patients at Day 8 and at 1 year postoperatively, respectively. At the 1-year follow-up evaluation (n = 23), 15 patients (65%) did not show growth of the residual tumor, 6 patients (26%) had regression of the residual tumor, and only 2 patients (9%) presented with tumor progression.CONCLUSIONSNear-total resection guided by electrophysiology represents a safe option in cases of difficult dissection of the facial nerve from the tumor. This seems to offer a good compromise between the goals of preserving facial nerve function and achieving maximum safe resection.

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

2011 ◽  
Vol 115 (5) ◽  
pp. 917-923 ◽  
Author(s):  
Raqeeb Haque ◽  
Teresa J. Wojtasiewicz ◽  
Paul R. Gigante ◽  
Mark A. Attiah ◽  
Brendan Huang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Residual Tumor ◽  
Subtotal Resection ◽  
Nerve Sparing ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Microsurgical Resection

Object The goal of this article was to show that a combination of facial nerve–sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS). Methods Records of individuals treated by a single surgeon with a facial nerve–sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.2%) of these patients required postoperative retreatment for a significant expansion of residual tumor after microsurgery. These 20 patients were re-treated with GKS. Results The rate of preservation of good facial nerve function (Grade I or II on the House-Brackmann scale) in patients treated with microsurgery for VS was 97%. Both subtotal and gross-total resection had excellent facial nerve preservation rates (97% vs 96%), although subtotal resection carried a higher risk that patients would require retreatment. In patients re-treated with GKS after microsurgery, the rate of facial nerve preservation was 95%. Conclusions In patients with tumors that cannot be managed with radiosurgery alone, a facial nerve–sparing resection followed by GKS for any significant regrowth provides excellent facial nerve preservation rates.

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.

Near Total Versus Gross Total Resection of Large Vestibular Schwannomas: Facial Nerve Outcome

2020 ◽  
Vol 19 (4) ◽  
pp. 414-421
Author(s):  
Julia R Schneider ◽  
Amrit K Chiluwal ◽  
Orseola Arapi ◽  
Kevin Kwan ◽  
Amir R Dehdashti
Keyword(s):  
Facial Nerve ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Gross Total Resection ◽  
Vestibular Schwannomas ◽  
Primary Data ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Total Resection

Abstract BACKGROUND Large vestibular schwannomas (VSs) with brainstem compression are generally reserved for surgical resection. Surgical aggressiveness must be balanced with morbidity from cranial nerve injury. The purpose of the present investigation is to evaluate the clinical presentation, management modality, and patient outcomes following near total resection (NTR) vs gross total resection (GTR) of large VSs. OBJECTIVE To assess facial nerve outcome differences between GTR and NTR patient cohorts. METHODS Between January 2010 and March 2018, a retrospective chart review was completed to capture patients continuously who had VSs with Hannover grades T4a and T4b. NTR was decided upon intraoperatively. Primary data points were collected, including preoperative symptoms, tumor size, extent of resection, and postoperative neurological outcome. RESULTS A total of 37 patients underwent surgery for treatment of large and giant (grade 4a and 4b) VSs. Facial nerve integrity was preserved in 36 patients (97%) at the completion of surgery. A total of 27 patients underwent complete resection, and 10 had near total (&gt;95%) resection. Among patients with GTR, 78% (21/27) had House-Brackmann (HB) grade I-II facial nerve function at follow-up, whereas 100% (10/10) of the group with NTR had HB grade I-II facial nerve function. Risk of meningitis, cerebrospinal fluid leak, and sinus thromboses were not statistically different between the 2 groups. There was no stroke, brainstem injury, or death. The mean follow-up was 36 mo. CONCLUSION NTR seems to offer a benefit in terms of facial nerve functional outcome compared to GTR in surgical management of large VSs without significant risk of recurrence.

Facial Nerve Evoked Potentials in the Cat

1988 ◽  
Vol 98 (2) ◽  
pp. 130-137 ◽  
Author(s):  
Ralph Metson
Keyword(s):  
Facial Nerve ◽  
Evoked Potential ◽  
Indirect Inference ◽  
Nerve Function ◽  
Human Beings ◽  
Stimulation Site ◽  
Signal Averaging ◽  
Facial Nerve Function ◽  
Proximal Site ◽  
Stimulation Of

Electrophysiologic facial nerve testing usually involves stimulation of the peripheral nerve in order to make some indirect inference about nerve integrity at a more proximal site of lesion. In an attempt to develop a test of facial nerve function by use of across-the-lesion testing, the cat facial nerve was stimulated percutaneously at the stylomastold foramen while retrograde activity through the temporal bone and cranium was monitored with scalp electrodes. A biphasic evoked potential could be identified within 3 milliseconds of stimulation with the use of a signal-averaging computer. This potential remained when the animal was paralyzed and disappeared when the facial nerve was cut proximal to the stimulation site. A potential of similar latency and duration but larger amplitude was recorded from the subarachnold space. Mapping studies indicated its origin to be a dipole located between ipsilateral mastoid and parietal recording sites that corresponded to the region of the intracranial facial nerve. Optimal stimulation and recording techniques for subsequent studies of human beings are discussed.

Congenital facial nerve agenesis

2001 ◽  
Vol 115 (1) ◽  
pp. 53-54 ◽  
Author(s):  
P. N. Jervis ◽  
P. D. Bull
Keyword(s):  
Surgical Treatment ◽  
Parotid Gland ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Surgical Procedure ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Stylomastoid Foramen ◽  
Unrelated Condition

We present a case of a seven-year-old child with a congenital facial palsy, diagnosed at birth, who subsequently developed a non-tuberculous mycobacterial (NTM) infection of the ipsilateral parotid gland. This required parotid exploration to treat the NTM disease with the intention of identifying and protecting the facial nerve to preserve any residual facial nerve function. At operation, thorough exploration revealed the complete absence of the nerve both at the stylomastoid foramen and more peripherally within the substance of the parotid gland. Exploration of the facial nerve for congenital facial paralysis is not normally indicated. Surgical treatment, if required, tends to involve the use of techniques such as cross facial nerve and free vascularized muscle grafting. To our knowledge this is the first reported case of complete congenital facial nerve agenesis, diagnosed incidentally during a surgical procedure for an unrelated condition.

The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas

2014 ◽  
Vol 120 (6) ◽  
pp. 1278-1287 ◽  
Author(s):  
Zhengnong Chen ◽  
Sampath Chandra Prasad ◽  
Filippo Di Lella ◽  
Marimar Medina ◽  
Enrico Piccirillo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Residual Tumor ◽  
Vestibular Schwannomas ◽  
Subtotal Resection ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Incomplete Excision ◽  
Kaplan Meier ◽  
Tumor Regrowth

Object The authors evaluated the behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas (VSs). Methods The case records of all patients who underwent surgical treatment of VSs were analyzed. All patients in whom an incomplete excision had been performed were analyzed. Incomplete excision was defined as near-total resection (NTR), subtotal resection (STR), and partial resection (PR). Tumors in the NTR and STR categories were followed up with a wait-and-rescan approach, whereas the tumors in the PR category were subjected to a second-stage surgery and were excluded from this series. All patients included in the study underwent baseline MRI at the 3rd and 12th postoperative months, and repeat imaging was subsequently performed every year for 7–10 years postoperatively or as indicated clinically. Preoperative and postoperative facial function was noted. Results Of the 2368 patients who underwent surgery for VS, 111 patients who had incomplete excisions of VSs were included in the study. Of these patients, 73 (65.77%) had undergone NTR and 38 (34.23%) had undergone STR. Of the VSs, 62 (55.86%) were cystic and 44 (70.97%) of these cystic VSs underwent NTR. The residual tumor was left behind on the facial nerve alone in 62 patients (55.86%), on the facial nerve and vessels in 2 patients (1.80%), on the facial nerve and brainstem in 15 patients (13.51%), and on the brainstem alone in 25 patients (22.52%). In the 105 patients with normal preoperative facial nerve function, postoperative facial nerve function was House-Brackmann (HB) Grades I and II in 51 patients (48.57%), HB Grade III in 34 patients (32.38%), and HB Grades IV–VI in 20 patients (19.05%). Seven patients (6.3%) showed evidence of tumor regrowth on follow-up MRI. All 7 patients (100%) who showed evidence of tumor regrowth had undergone STR. No patient in the NTR group exhibited regrowth. The Kaplan-Meier plot demonstrated a 5-year tumor regrowth-free survival of 92%, with a mean disease-free interval of 140 months (95% CI 127–151 months). The follow-up period ranged from 12 to 156 months (mean 45.4 months). Conclusions The authors' report and review of the literature show that there is undoubtedly merit for NTR and STR for preservation of the facial nerve. On the basis of this they propose an algorithm for the management of incomplete VS excisions. Patients who undergo incomplete excisions must be subjected to follow-up MRI for a period of at least 7–10 years. When compared with STR, NTR via an enlarged translabyrinthine approach has shown to have a lower rate of regrowth of residual tumor, while having almost the same result in terms of facial nerve function.

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 An Evidence-Based Vestibular Schwannoma Surgical Outcome Grading Scale for Large-to-Giant Vestibular Schwannomas

2021 ◽  
Author(s):  
Nida Fatima ◽  
Gregory P. Lekovic
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Grading System ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Mesh Terms ◽  
Large Vestibular Schwannoma

Abstract Objectives: The objective of this study was to determine the relationship between facial nerve function and extent of resection (EOR) as outcomes in the surgical management of large vestibular schwannoma (VS) (≥ 2.5 cm maximal) and evaluate use of a new grading system that incorporates both outcomes.Methods: We conducted a systematic review of the electronic databases using different MeSH terms from 1990 to 2021. 5,623 patients from 56 studies were found appropriate for inclusion in the study. Surgical approach was reported in 5,144 patients, including translabyrinthine approach (TL) in 43.3% (n=2,225), retrosigmoid (RS) approach in 56.3% (n=2,899), retrolabyrinthine (RL) approach in 0.3% (n=16), and extended translabyrinthine (EX) approach in 0.1% (n=4). The proposed VS Grading System defines outcomes of gross total resection (GTR), near total resection (NTR) and subtotal resection (STR) with good facial nerve function [House-Brackmann (HB) Grade I-II] as Classes A, B and C respectively. Those with poor facial nerve outcome (HB III-VI) are graded as Classes D, E and F, respectively. Results:. As expected, patients with STR had a higher likelihood of better facial nerve outcomes (HB I-II) compared to NTR [Odds Ratio (OR): 7.30, 95%CI: 2.45-12.1, p=0.004] and GTR (OR: 9.61, 95%CI: 3.61-15.6, p=0.002), while NTR had better facial nerve outcome than GTR (OR: 1.5, 95%CI: 1.14-4.6, p<0.0001). A Class A result, representing the best possible outcome, was obtained in 55.8% of TL vs. 49.4% undergoing RS approach. Conclusion: Complete surgical resection with preservation of facial nerve function is the gold standard for large VS.

Sign in / Sign up

Export Citation Format

Share Document