scholarly journals Surgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression

2020 ◽  
pp. 1-12
Author(s):  
Juliana Rotter ◽  
Victor M. Lu ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Colin L. W. Driscoll ◽  
...  
Keyword(s):  
Systematic Review ◽  
Facial Nerve ◽  
Meta Analysis ◽  
Management Strategies ◽  
Complication Rates ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Operative Outcomes ◽  
Facial Nerve Schwannoma

OBJECTIVEIntracranial facial nerve schwannomas (FNS) requiring treatment are frequently recommended for surgery or stereotactic radiosurgery (SRS). The objective of this study was to compare facial nerve function outcomes between these two interventions for FNS via a systematic review and meta-analysis.METHODSA search of the Ovid EMBASE, PubMed, SCOPUS, and Cochrane databases from inception to July 2019 was conducted following PRISMA guidelines. Articles were screened against prespecified criteria. Facial nerve outcomes were classified as improved, stabilized, or worsened by last follow-up. Incidence was pooled by random-effects meta-analysis of proportions.RESULTSThirty-three articles with a pooled cohort of 519 patients with FNS satisfied all criteria. Twenty-five articles described operative outcomes in 407 (78%) patients; 10 articles reported SRS outcomes in 112 (22%). In the surgical cohort, facial nerve function improved in 23% (95% CI 15%–32%), stabilized in 41% (95% CI 32%–50%), and worsened in 30% (95% CI 21%–40%). In the SRS cohort, facial nerve function was improved in 20% (95% CI 9%–34%), stable in 66% (95% CI 54%–78%), and worsened in 9% (95% CI 3%–16%). Compared with SRS, microsurgery was associated with a significantly lower incidence of stable facial nerve function (p < 0.01) and a significantly higher incidence of worsened facial nerve function (p < 0.01). Tumor progression and complication rates were comparable. Outcome certainty assessments were very low to moderate for all parameters.CONCLUSIONSUnfavorable facial nerve function outcomes are associated with surgical treatment of intracranial FNS, whereas stable facial nerve function outcomes are associated with SRS. Therefore, SRS should be recommended to patients with FNS who require treatment, and surgery should be reserved for patients with another indication, such as decompression of the brainstem. Further study is required to definitively optimize and validate management strategies for these rare skull base tumors.

Surgery versus Radiosurgery for Facial Nerve Schwannoma: Systematic Review and Meta-analysis of Facial Nerve Function

2020 ◽  
Author(s):  
Juliana Rotter ◽  
Victor M. Lu ◽  
Avital Perry ◽  
Christopher S. Graffeo ◽  
Matthew L. Carlson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Facial Nerve ◽  
Meta Analysis ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Facial Nerve Schwannoma

Long-term outcomes of patients with primary or residual vestibular schwannoma treated with LINAC-based stereotactic radiosurgery: a single-centre experience

2020 ◽  
pp. 1-7
Author(s):  
Patricia Sebastian ◽  
Subhashini John ◽  
Jebakarunya Reddy ◽  
Sunitha Susan Varghese ◽  
Harshad Arvind Vanjare ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Response To Treatment ◽  
Complication Rates ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumour Control ◽  
Prior Surgery ◽  
Facial Function

Abstract Aim: Vestibular schwannomas (VS) are benign slow-growing tumours treated either with microsurgery or stereotactic radiosurgery (SRS) or both. The aim of this study was to correlate the outcome factors—tumour control and adverse factors—facial nerve function and hearing loss with patient and treatment factors. Materials and methods: A retrospective review of the records of 98 patients with 99 VS treated from June 2007 to June 2014, all patients receiving Linear Accelerator (LINAC)-based SRS. Results: Median follow-up period was 5·6 years (range: 1–12 years). The response to treatment was stable disease in 37 (37·4%), regression in 46 (46·5%), asymptomatic minimal progression in 9 (9·1%) and symptomatic progression in 5 (5%) and unknown in 2 (2%) patients. There was no evidence of SRS induced tissue damage on magnetic resonance scans for any. Hearing preservation rate after SRS was 92%. The patients who developed worsening of facial function were predominantly in the cohort that had prior surgery. Findings: SRS is an effective modality to treat VS lesser than 3 cm in size. Tumour control rate was 95% with a median follow-up period of 5·6 years. The complication rates were 8% each for facial function worsening and worsening of hearing. Prior surgery was a statistically significant factor that affected facial nerve function deterioration.

Sporadic unilateral vestibular schwannoma in the pediatric population

2009 ◽  
Vol 4 (2) ◽  
pp. 125-129 ◽  
Author(s):  
Brian P. Walcott ◽  
Ganesh Sivarajan ◽  
Bronislava Bashinskaya ◽  
Douglas E. Anderson ◽  
John P. Leonetti ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Size ◽  
Pediatric Population ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Duration Of Symptoms

Object Vestibular schwannomas (VSs) are rare in the pediatric population. Most often, these lesions manifest as a bilateral disease process in the setting of neurofibromatosis Type 2. Even in the absence of additional clinical diagnostic criteria, the presentation of a unilateral VS in a young patient may be a harbinger of future penetrance for this hereditary tumor syndrome. Methods The authors retrospectively reviewed the charts of a cohort of 7 patients who presented with apparently sporadic, unilateral VSs. These patients had previously undergone surgery via translabyrinthine, retrosigmoid, or combined approaches. Clinical outcomes were reviewed with emphasis on facial nerve function and follow-up for signs and symptoms of a heritable disorder. Results All patients underwent microsurgical resection in a multidisciplinary effort by the senior authors. The average tumor size was 4.57 cm, with an average duration of symptoms prior to definitive diagnosis of 31.2 months. The tumor size at the time of presentation followed a trend different from reports in adults, while the duration of symptoms did not. At a follow-up average of 6.3 years (range 1–12 years), 100% of patients demonstrated good facial function (House-Brackmann Grade I or II). No patient in this cohort demonstrated symptoms, objective signs, or genetic analysis indicating the presence of neurofibromatosis Type 2. Conclusions Diagnosis and management of sporadic, unilateral VSs in children is complicated by clinical presentations and surgical challenges unique from their adult counterparts. Careful consideration should be given to a heritable genetic basis for sporadic unilateral VS in the pediatric population. Results of genetic testing do not preclude the necessity for long-term follow-up and systemic investigation. In patients who present with large tumors, preliminary experience leads the authors to suggest that a combined retrosigmoid-translabyrinthine approach offers the greatest opportunity for preservation of facial nerve function.

scholarly journals Facial Nerve Meningioma: A Case Mimicking Facial Nerve Schwannoma

2020 ◽  
pp. 014556132096258
Author(s):  
Wei Gao ◽  
Dingjing Zi ◽  
Lianjun Lu
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Growth Patterns ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Reconstruction ◽  
Radiological Features ◽  
Facial Nerve Reconstruction ◽  
Facial Nerve Schwannoma ◽  
Grade Iii

Facial nerve meningioma is exceedingly rare and tends to affect the geniculate ganglion. We present a case of facial nerve meningioma located in the internal auditory canal with a “labyrinthine tail,” mimicking facial nerve schwannoma. The clinical and radiological features, growth patterns, and surgical management were reviewed. Progressive facial paralysis was the main syndrome, similar to other facial nerve tumors. When facial nerve function is worse than House-Brackmann grade III, surgical resection should be performed with facial nerve reconstruction.

Middle Fossa Approach for Resection of Vestibular Schwannomas: A Decade of Experience

2018 ◽  
Vol 16 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Jennifer A Kosty ◽  
Shawn M Stevens ◽  
Yair M Gozal ◽  
Vincent A DiNapoli ◽  
Smruti K Patel ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Size ◽  
Pure Tone ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Pure Tone Average ◽  
Class A ◽  
The Mean

AbstractBACKGROUNDThe middle cranial fossa (MCF) approach is a challenging surgical technique for the resection of small and intermediate sized, primarily intracanalicular, vestibular schwannomas (VS), with the goal of hearing preservation (HP).OBJECTIVETo describe a decade-long, single institutional experience with the MCF approach for resection of VS.METHODSThis is a retrospective cohort study of 63 patients who underwent the MCF approach for resection of VS from 2006 to 2016. Audiometric data included pure-tone average (PTA), low-tone pure-tone average (LtPTA), word recognition score, and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification at presentation and follow-up. Patients with postoperative serviceable (AAO-HNS class A-B) and/or useful (AAO-HNS class A-C) hearing were compared to those without HP. Facial nerve function was assessed using the House–Brackmann scale.RESULTSThe mean age and duration of follow-up were 50 ± 13 yr and 21 ± 21 mo, respectively. The mean tumor size was 10 ± 4 mm. The serviceable and usable HP rates were 54% and 50%, respectively. Some residual hearing was preserved in 71% of patients. Large tumor size (P = .05), volume (P = .03), and extrameatal tumor extension (P = .03) were associated with poor audiometric outcomes. The presence of a fundal fluid cap (P = .01) was a favorable finding. At definitive testing, LtPTA was significantly better preserved than traditional PTA (P = .01). Facial nerve outcomes, tumor control rates, and durability of audiometric outcomes were excellent. 47% of patients pursued aural rehabilitation.CONCLUSIONIn our series, the MCF approach for VS provided excellent rates of tumor and facial nerve function, with durable serviceable HP.

Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. E91-E98 ◽  
Author(s):  
Gautam U Mehta ◽  
Gregory P Lekovic ◽  
William H Slattery ◽  
Derald E Brackmann ◽  
Hao Long ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Radiation Effects ◽  
Progression Free Survival ◽  
Functional Improvement ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Multicenter Cohort Study ◽  
Facial Numbness

Abstract BACKGROUND Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined. OBJECTIVE To analyze the effect of facial nerve segment involvement on functional outcome for these tumors. METHODS Patients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function. RESULTS A total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients). CONCLUSION SRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.

Outcome After Microsurgery for Meningiomas Involving the Internal Auditory Canal

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1236-1242 ◽  
Author(s):  
Kajetan L von Eckardstein ◽  
Colin L W Driscoll ◽  
Michael J Link
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Entire Group ◽  
Surgical Removal ◽  
Nerve Function ◽  
Canal Wall ◽  
Facial Nerve Function ◽  
Clinical Exam ◽  
Hearing Outcomes

Abstract BACKGROUND: The subset of patients suffering from meningiomas truly originating in or extending into the internal auditory canal is not well described in the literature. OBJECTIVE: To evaluate postoperative facial motor and hearing outcomes in patients undergoing resection of meningiomas originating in or extending into the internal auditory canal. METHODS: Chart reviews were done of 19 consecutive patients undergoing surgery for meningiomas originating in or extending into the internal auditory canal at the Mayo Clinic, Rochester, with emphasis on clinical exam and audiometry. RESULTS: Median follow-up for the entire group was 29 months. Seventy-four percent of patients had stable facial nerve function. One patient experienced improvement. Postoperative cochlear nerve function was unchanged in 74% of patients and worsened in 21% of patients. One patient with a sudden preoperative hearing loss improved to full hearing at 3 months. CONCLUSION: Every attempt should be made to preserve hearing and facial motor function in surgical removal of posterior fossa meningiomas that originate in or extend into the internal auditory canal. Normal or nearly normal facial nerve function can be preserved in 88% of patients presenting with normal facial nerve function; serviceable hearing can be preserved in 92% of patients who present with normal hearing. A standard retrosigmoid craniotomy with drilling of the posterior canal wall of the internal auditory canal worked well in the majority of cases.

scholarly journals Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Victor M. Schuettfort ◽  
Benjamin Pradere ◽  
Fahad Quhal ◽  
Hadi Mostafaei ◽  
Ekaterina Laukhtina ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bladder Cancer ◽  
Meta Analysis ◽  
Invasive Bladder Cancer ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
Bladder Sparing

Abstract Objective We conducted a systematic review and meta-analysis to assess the available literature regarding the surgical and oncologic outcomes of patients undergoing salvage radical cystectomy (SV-RC) for recurrence or failure of bladder sparing therapy (BST) for muscle-invasive bladder cancer (MIBC). Methods We searched MEDLINE (PubMed), EMBASE and Google Scholar databases in May 2020. We included all studies of patients with ≥ cT2N0/xM0 bladder cancer that were eligible for all treatment modalities at the time of treatment decision who underwent BST including radiotherapy (RTX). A meta-analysis was conducted to calculate the pooled rate of several variables associated with an increased need for SV-RC. Study quality and risk of bias were assessed using MINORS criteria. Results 73 studies comprising 9110 patients were eligible for the meta-analysis. Weighted mean follow-up time was 61.1 months (range 12–144). The pooled rate of non-response to BST and local recurrence after BST, the two primary reasons for SV-RC, was 15.5% and 28.7%, respectively. The pooled rate of SV-RC was 19.2% for studies with a follow-up longer than 5 years. Only three studies provided a thorough report of complication rates after SV-RC. The overall complication rate ranged between 67 and 72% with a 30-day mortality rate of 0–8.8%. The pooled rates of 5 and 10-year disease-free survival after SV-RC were 54.3% and 45.6%, respectively. Conclusion Approximately one-fifth of patients treated with BST with a curative intent eventually require SV-RC. This procedure carries a proportionally high rate of complications and is usually accompanied by an incontinent urinary diversion.

Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study

2007 ◽  
Vol 116 (7) ◽  
pp. 542-549 ◽  
Author(s):  
Sertac Yetiser ◽  
Ugur Karapinar
Keyword(s):  
Facial Nerve ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cranial Nerves ◽  
Facial Nerve Paralysis ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Reliable Technique ◽  
Nerve Paralysis ◽  
Nerve Anastomosis

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.

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