scholarly journals Vestibular schwannoma manifesting with hemifacial spasm in a young woman: clinical considerations and tumor removal with hearing preservation. 2-Dimensional operative video

2021 ◽  
Vol 5 (2) ◽  
pp. V11
Author(s):  
Carlos Candanedo ◽  
Marrigje A. de Jong ◽  
Avner Michaeli ◽  
Samuel Moscovici ◽  
José E. Cohen ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Hemifacial Spasm ◽  
Hearing Preservation ◽  
Neurophysiological Monitoring ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Rare Presentation ◽  
Clinical Considerations ◽  
Challenging Situation ◽  
Complete Tumor

Hemifacial spasm (HFS) is a rare presentation of vestibular schwannoma. The authors present their experience with a 27-year-old woman who presented with normal hearing and HFS, which was the single neurological manifestation of an 18-mm vestibular schwannoma. In this challenging situation, the treatment goals were maximal tumor removal with preservation of hearing and facial nerve function and cure of the HFS. The authors achieved these goals, performing complete tumor removal via a retrosigmoid approach, assisted with neurophysiological monitoring and a 45°-angle QEVO endoscope. In the video, they explain the clinical, radiological, and surgical considerations and demonstrate the surgical technique. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2099

Suboccipital Retrosigmoid Approach for Removal of Vestibular Schwannomas: Facial Nerve Function and Hearing Preservation

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. 560-570 ◽  
Author(s):  
Ivan Ciric ◽  
Jin-cheng Zhao ◽  
Sami Rosenblatt ◽  
Richard Wiet ◽  
Brian O'shaughnessy
Keyword(s):  
Prognostic Factors ◽  
Surgical Technique ◽  
Facial Nerve ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Neurophysiological Monitoring ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Neurovascular Anatomy

Abstract IN THIS REPORT, we discuss the pertinent bony, arachnoid, and neurovascular anatomy of vestibular schwannomas that has an impact on the surgical technique for removal of these tumors, with the goal of facial nerve and hearing preservation. The surgical technique is described in detail starting with anesthesia, positioning, and neurophysiological monitoring and continuing with the exposure, technical nuances of tumor removal, hemostasis, and closure. Positive prognostic factors for hearing preservation are also highlighted.

scholarly journals Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications

2009 ◽  
Vol 27 (4) ◽  
pp. E9 ◽  
Author(s):  
A. Samy Youssef ◽  
Angela E. Downes
Keyword(s):  
Facial Nerve ◽  
Functional Outcome ◽  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Evoked Potential ◽  
Hearing Preservation ◽  
Auditory Evoked Potential ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Clinical Series

Object Intraoperative neurophysiological monitoring has become an integral part of vestibular schwannoma surgery. The aim of this article was to review the different techniques of intraoperative neurophysiological monitoring in vestibular schwannoma surgery, identify the clinical impact of certain pathognomonic patterns on postoperative outcomes of facial nerve function and hearing preservation, and highlight the role of postoperative medications in improving delayed cranial nerve dysfunction in the different reported series. Methods The authors performed a review of the literature regarding intraoperative monitoring in acoustic/vestibular schwannoma surgery. The different clinical series representing different monitoring techniques were reviewed. All the data from clinical series were analyzed in a comprehensive and comparative model. Results Intraoperative brainstem auditory evoked potential monitoring, direct cochlear nerve action potential monitoring, and facial nerve electromyography are the main tools used to assess the functional integrity of an anatomically intact cranial nerve. The identification of pathognomonic brainstem auditory evoked potential and electromyography patterns has been correlated with postoperative functional outcome. Recently, perioperative administration of intravenous hydroxyethyl starch and nimodipine as vasoactive and neuroprotective agents was shown to improve vestibular schwannoma functional outcome in few reported studies. Conclusions Recent advances in electrophysiological technology have considerably contributed to improvement in functional outcome of vestibular neuroma surgery in terms of hearing preservation and facial nerve paresis. Perioperative intravenous nimodipine and hydroxyethyl starch may be valuable additions to surgery.

Surgical Management of Intrinsic Tumors of the Facial Nerve

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 740-752 ◽  
Author(s):  
Sampath Chandra Prasad ◽  
Melissa Laus ◽  
Manjunath Dandinarasaiah ◽  
Enrico Piccirillo ◽  
Alessandra Russo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Surgical Management ◽  
Nerve Palsy ◽  
Surgical Intervention ◽  
Facial Nerve Palsy ◽  
Hearing Preservation ◽  
Rare Entity ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
The Mean

Abstract BACKGROUND Intrinsic tumors of the facial nerve are a rare entity. Dealing with this subset of tumors is challenging both in terms of decision making and surgical intervention. OBJECTIVE To review the outcomes of surgical management of facial nerve tumors and cable nerve graft interpositioning. METHODS A retrospective analysis was performed at a referral center for skull base pathology. One hundred fifteen patients who were surgically treated for facial nerve tumors were included. In case of nerve interruption during surgery, the cable nerve interpositioning technique was employed wherein the facial nerve palsy lasted for less than 1-yr duration. In cases of facial nerve palsy lasting for greater than 1 yr, the nerve was restituted by a hypoglossal facial coaptation. RESULTS Various degrees of progressive paralysis were seen in 84 (73%) cases. Sixty nine (60%) of the tumors involved multiple segments of the facial nerve. Sixty-two (53.9%) tumors involved the geniculate ganglion. Seventy four (64.3%) of the cases were schwannomas. Hearing preservation surgeries were performed in 60 (52.1%). Ninety one (79.1%) of the nerves that were sectioned in association with tumor removal were restituted primarily by interposition cable grafting. The mean preoperative House-Brackmann grading of the facial nerve was 3.6. The mean immediate postoperative grading was 5.4, which recovered to a mean of 3.4 at the end of 1 yr. CONCLUSION In patients with good facial nerve function (House-Brackmann grade I-II), a wait-and-scan approach is recommended. In cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve.

Meningioma Involving Meckel's Cave: Transpetrosal Surgical Anatomy and Clinical Considerations

2002 ◽  
Vol 111 (9) ◽  
pp. 850-854 ◽  
Author(s):  
Daniel I. Choo ◽  
David L. Steward ◽  
Myles L. Pensak
Keyword(s):  
Facial Pain ◽  
Skull Base Surgery ◽  
Surgical Anatomy ◽  
Tumor Removal ◽  
Meckel’S Cave ◽  
Complete Tumor Removal ◽  
Meckel's Cave ◽  
Intimate Knowledge ◽  
Clinical Considerations ◽  
Complete Tumor

Meningiomas originating in Meckel's cave (MC) are uncommon lesions that represent 1% of all intracranial meningiomas. Innovations in skull base surgery have enabled resection of these lesions with less morbidity, but require an intimate knowledge of both lesional pathology and regional microneuroanatomy. To review the surgical and clinical considerations involved in the management of MC meningiomas, we retrospectively reviewed data from patients who underwent transpetrosal resection of primary MC meningiomas between 1984 and 1998. Of 146 patients who underwent transpetrosal removal of meningiomas, 7 were believed to have tumors originating in MC. All 7 patients presented with trigeminal dysfunction, facial pain, and/or headache. Complete tumor removal was achieved in 5 of the 7 patients. Facial hypoesthesia or anesthesia, paralysis of cranial nerve VI, and ophthalmoplegia were among the postoperative complications encountered. Meningiomas of MC represent treatable lesions whose diagnosis requires prompt imaging of patients with trigeminal dysfunction and symptoms of facial pain and headache.

Type 2 neurofibromatosis: the need for supraregional care?

1993 ◽  
Vol 107 (5) ◽  
pp. 401-406 ◽  
Author(s):  
D. Gareth R. Evans ◽  
Richard Ramsden ◽  
Susan M. Huson ◽  
Rodney Harris ◽  
Richard Lye ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Definitive Treatment ◽  
Facial Nerve Function ◽  
Operative Results ◽  
Nerve Preservation ◽  
Quality Life

The results of a U.K. study of 145 cases of type 2 neurofibromatosis has shown generally very poor operative results in terms of hearing and facial nerve preservation. Only 9 out of 118 vestibular schwannoma (acoustic neuroma) operations resulted in any clinically detectable hearing preservation and only 32 left the patient with good or normal (House grade I or II) ipsilateral facial nerve function. Although operation is still the definitive treatment of vestibular schwannoma (acoustic neuroma) and may be a lifesaving procedure, it appears that the evidence in favour of early operation is only valid when carried out in highly specialized centres. The special problems of NF2 cases who may go on to develop multiple spinal and cranial tumours making them wheelchair bound and blind as well as deaf warrants a careful experienced approach. Timing of operations may be critical for the enhancement of useful years of quality life. We therefore propose the setting up of a national NF2 register, with the management of cases at a few supraregional centres.

Facial nerve function after vestibular schwannoma surgery

2011 ◽  
Vol 115 (4) ◽  
pp. 820-826 ◽  
Author(s):  
Maurizio Falcioni ◽  
Paolo Fois ◽  
Abdelkader Taibah ◽  
Mario Sanna
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Tumor Size ◽  
Middle Cranial Fossa ◽  
Optimal Size ◽  
Tumor Diameter ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Total Tumor Removal

Object The object of this study was to evaluate long-term postoperative facial nerve (FN) function in patients undergoing vestibular schwannoma (VS) surgery. Methods The authors retrospectively reviewed the clinical course of patients affected by isolated VSs with normal preoperative FN function, with no previous surgical or radiotherapeutic treatment, and who underwent surgery between 1987 and 2007. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) scale. The minimum postoperative follow-up was 12 months. Results Among the 1550 patients surgically treated at the authors' center, 1151 matched inclusion criteria for the present study. The FN was anatomically interrupted in 48 cases (4.2%), and 51 patients (4.4%) underwent subtotal tumor removal and were considered separately. Among the 1052 patients with anatomically preserved FNs and total tumor removal, 684 (65%) enjoyed postoperative HB Grade I or II and 309 (29.4%) enjoyed Grade III, with the remaining 59 cases (5.6%) suffering unsatisfactory results (HB Grades IV–VI). As expected, FN function results deteriorated in cases of larger tumors. Conclusions The main factor influencing postoperative FN function was tumor size. Although there was a progressive deterioration in FN function outcome in relation to tumor size, a cutoff point between satisfactory and unsatisfactory results could be identified at around 2 cm in maximum extrameatal tumor diameter, with the “optimal size” for surgery identified at < 1 cm. This finding emphasizes the importance of an early diagnosis and should be kept in mind when selecting the correct timing for VS removal. For small lesions, the results following a middle cranial fossa approach were significantly worse as compared with those following the translabyrinthine and retrosigmoidretrolabyrinthine approaches.

Preservation of Function in Vestibular Schwannoma Surgery

2007 ◽  
Vol 60 (suppl_2) ◽  
pp. ONS-124-ONS-128 ◽  
Author(s):  
Alireza Gharabaghi ◽  
Amir Samii ◽  
Andrei Koerbel ◽  
Steffen K. Rosahl ◽  
Marcos Tatagiba ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Acoustic Neuroma ◽  
Patient Positioning ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Presurgical Evaluation ◽  
Microsurgical Techniques

Abstract THE MANAGEMENT AND surgical technique for microsurgical tumor removal of vestibular schwannomas (acoustic neuroma) with the suboccipital retrosigmoid approach and semi-sitting patient positioning is described. An emphasis is placed on the preservation of auditory and facial nerve function with a stepwise description of the technical and operative nuances, including presurgical evaluation, positioning, anesthesiological and neurophysiological aspects, approach, microsurgical techniques, and postsurgical care.

Effect of tumor removal on tinnitus in patients with vestibular schwannoma

2010 ◽  
Vol 112 (1) ◽  
pp. 152-157 ◽  
Author(s):  
Katsuharu Kameda ◽  
Tadahisa Shono ◽  
Kimiaki Hashiguchi ◽  
Fumiaki Yoshida ◽  
Tomio Sasaki
Keyword(s):  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Vestibular Schwannomas ◽  
Tumor Removal ◽  
Significant Difference ◽  
Before And After ◽  
The Status ◽  
Lateral Suboccipital Approach ◽  
Suboccipital Approach

Object Tinnitus is one of the most common symptoms in patients with vestibular schwannomas (VSs), but the effect of surgery on this symptom has not been fully evaluated. The aim of this study was to define the effect on tinnitus of tumor removal, cochlear nerve resection, and useful hearing preservation in patients with VSs. Methods The authors retrospectively analyzed the status of tinnitus before and after surgery in 242 patients with unilateral VSs who underwent surgery via the retrosigmoid lateral suboccipital approach. Results Of 242 patients, 171 (70.7%) complained of tinnitus before surgery; the symptom disappeared in 25.2%, improved in 33.3%, remained unchanged in 31.6%, and worsened in 9.9% of these cases after tumor removal. In the 171 patients with preoperative tinnitus, the cochlear nerve was resected in 85 (49.7%) and preserved in 86 (50.3%), but there was no significant difference in the incidence of postoperative tinnitus between these 2 groups (p = 0.293). In the 71 patients without preoperative tinnitus, the symptom developed postoperatively in 6 cases (8.5%). Among those without preoperative tinnitus, the cochlear nerve was resected in 45 cases (63.4%) and tinnitus appeared postoperatively in 3 (6.7%). The authors also analyzed the association between postoperative tinnitus and useful hearing preservation, but could not find any statistically significant association between the 2 factors (p = 0.153). Conclusions Tumor removal via the retrosigmoid lateral suboccipital approach may provide some chance for improvement of tinnitus in patients with VSs; however, neither cochlear nerve resection nor useful hearing preservation affects the postoperative development of tinnitus.

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