Linear accelerator–based radiosurgery for vestibular schwannoma

Despite major advances in skull base surgery and microsurgical techniques, surgery for vestibular schwannoma (VS) carries a risk of complications. Some are inherent to general anesthesia and surgery of any type and include myocardial infarction, pneumonia, pulmonary embolism, and infection. Some are specific to neurosurgery in this area of the brain, and include hydrocephalus, cerebrospinal fluid leak, facial nerve paralysis, facial numbness, hearing loss, ataxia, dysphagia, and major stroke. Even in the hands of very experienced acoustic surgeons, these risks cannot be eliminated. Radiosurgery provides an outpatient, noninvasive alternative for the treatment of small acoustic schwannomas. Initially radiosurgery was undertaken in “high-risk” patients, including the elderly, those with severe medical comorbidities, and those in whom tumors recurred after surgery. Additionally, a high rate of cranial nerve morbidity was reported. With improvements in dosimetry planning and dose selection, however, authors practicing at radiosurgical centers now report very low complication rates, as well as high tumor control rates. In this report the authors specifically review the results of linear accelerator–based radiosurgery for VS and compare these outcomes with the best surgical alternatives.

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Results of hemihypoglossal-facial nerve anastomosis in the treatment of facial nerve paralysis after failed stereotactic radiosurgery for vestibular schwannoma

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.16.03385-3 ◽

2016 ◽

Vol 61 (2) ◽

Author(s):

Tomasz A. Dziedzic ◽

Przemysław Kunert ◽

Andrzej Marchel

Keyword(s):

Facial Nerve ◽

Stereotactic Radiosurgery ◽

Vestibular Schwannoma ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

Nerve Anastomosis

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Translabyrinthine microsurgical resection of small vestibular schwannomas

Journal of Neurosurgery ◽

10.3171/2017.2.jns162287 ◽

2018 ◽

Vol 129 (1) ◽

pp. 128-136 ◽

Cited By ~ 12

Author(s):

Marc S. Schwartz ◽

Gregory P. Lekovic ◽

Mia E. Miller ◽

William H. Slattery ◽

Eric P. Wilkinson

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Sinus Thrombosis ◽

Treatment Options ◽

Previous Treatment ◽

Cerebrospinal Fluid Leak ◽

Neurofibromatosis Type ◽

Additional Treatment ◽

Vestibular Schwannomas ◽

Tumor Control

OBJECTIVETranslabyrinthine resection is one of a number of treatment options available to patients with vestibular schwannomas. Though this procedure is hearing destructive, the authors have noted excellent clinical outcomes for patients with small tumors. The authors review their experience at a tertiary acoustic neuroma referral center in using the translabyrinthine approach to resect small vestibular schwannomas. All operations were performed by a surgical team consisting of a single neurosurgeon and 1 of 7 neurotologists.METHODSData from a prospectively maintained clinical database were extracted and reviewed. Consecutive patients with a preoperative diagnosis of vestibular schwannoma that had less than 1 cm of extension into the cerebellopontine angle, operated on between 2008 and 2013, were included. Patents with neurofibromatosis Type 2, previous treatment, or preexisting facial weakness were excluded. In total, 107 patients were identified, 74.7% of whom had poor hearing preoperatively.RESULTSPathologically, 6.5% of patients were found to have a tumor other than vestibular schwannoma. Excluding two malignancies, the tumor control rates were 98.7%, as defined by absence of radiographic disease, and 99.0%, as defined by no need for additional treatment. Facial nerve outcome was normal (House-Brackmann Grade I) in 97.2% of patients and good (House-Brackmann Grade I–II) in 99.1%. Complications were cerebrospinal fluid leak (4.7%) and sigmoid sinus thrombosis (0.9%), none of which led to long-term sequelae.CONCLUSIONSTranslabyrinthine resection of small vestibular schwannomas provides excellent results in terms of complication avoidance, tumor control, and facial nerve outcomes. This is a hearing-destructive operation that is advocated for selected patients.

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Comparison of radiosurgery and conventional surgery for the treatment of glomus jugulare tumors

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.2.4 ◽

2004 ◽

Vol 17 (2) ◽

pp. 22-30 ◽

Cited By ~ 73

Author(s):

Oren N. Gottfried ◽

James K. Liu ◽

William T. Couldwell

Keyword(s):

Tumor Size ◽

Treatment Options ◽

Cerebrospinal Fluid Leak ◽

Residual Tumor ◽

Morbidity Rate ◽

Tumor Control ◽

Complication Rates ◽

Glomus Jugulare ◽

Initial Surgery ◽

The Mean

Object The optimal management of glomus jugulare tumors remains controversial. Available treatments were once associated with poor outcomes and significant complication rates. Advances in skull base surgery and the delivery of radiation therapy by stereotactic radiosurgery have improved the results obtained using these treatment options. The authors summarize and compare the contemporary outcomes and complications for these therapies. Methods Papers published between 1994 and 2004 that detailed the use of radiosurgery or surgery to treat glomus jugulare tumors were reviewed. Eight radiosurgery series including 142 patients and seven surgical studies including 374 patients were evaluated for neurological outcome, change in tumor size (radiosurgery) or percent of total resection (surgery), recurrences, tumor control, need for further treatment, and complications. The mean age at treatment for patients who underwent surgery and radiosurgery was 47.3 and 56.7 years, respectively. The mean follow-up duration was 49.2 and 39.4 months, respectively. The surgical control rate was 92.1%, with 88.2% of tumors totally resected in the initial surgery. A cerebrospinal fluid leak occurred in 8.3% of patients who underwent surgery and recurrences were found in 3.1%; the mortality rate was 1.3%. Among patients who underwent radiosurgery, tumors diminished in 36.5%, whereas 61.3% had no change in tumor size, and subjective or objective improvements occurred in 39%. Despite the presence of residual tumor in 100% of radiosurgically treated patients, recurrences were found in only 2.1%, the morbidity rate was 8.5%, and there were no deaths. Conclusions Death and recurrences after these treatments are infrequent, and therefore both treatments are considered to be safe and efficacious. Although surgery is associated with higher morbidity rates, it immediately and totally eliminates the tumor. The radiosurgery results are very promising, although the incidence of late recurrence (after 10–20 years) is unknown.

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Facial nerve paralysis occurring 4 days following stereotactic radiosurgery for a vestibular schwannoma

Asian Journal of Neurosurgery ◽

10.4103/ajns.ajns_53_17 ◽

2019 ◽

Vol 14 (1) ◽

pp. 262

Author(s):

KevinKwong-Hon Chow ◽

Abdulrazag Ajlan ◽

AllenLin Ho ◽

Gordon Li ◽

ScottGerard Soltys

Keyword(s):

Facial Nerve ◽

Stereotactic Radiosurgery ◽

Vestibular Schwannoma ◽

Facial Nerve Paralysis ◽

Nerve Paralysis

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Complications of cochlear implantation surgery in Zagazig University Hospitals

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00136-3 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Alaa Eldin M. Elfeky ◽

Adly A. Tantawy ◽

Asmaa M. Ibrahim ◽

Ibrahim M. Saber ◽

Said Abdel-Monem

Keyword(s):

Facial Nerve ◽

Cochlear Implant ◽

Cochlear Implantation ◽

Csf Leak ◽

Facial Nerve Paralysis ◽

Complication Rates ◽

Chorda Tympani Nerve ◽

University Hospitals ◽

Nerve Paralysis ◽

Major Complications

Abstract Background Cochlear implantation (CI) has been established worldwide as the surgical treatment for individuals with bilateral severe to profound hearing loss. Complications due to surgery are minimal and are often encountered in cases with congenital anomalies of the temporal bone and inner ear. Complications in CI are related to malfunctioning of the device or the process of wound healing. In most cochlear implant centers, as the surgeon’s skill and clinical expertise in managing various cochlear implant cases improve with years of experience, the complication rates ideally come down over time. This article is intended to describe the most common surgical complications of cochlear implantation in Zagazig University Hospitals. This retrospective study included 130 patients who underwent cochlear implantation in Zagazig University Hospitals from 2016 to 2018. The patients were 61 males and 69 females; their ages ranged between 2 and 6 years old with a mean age of 4.3. This study aims to provide feedback on the common complications of CI surgery at our institution to help the reduction of its incidence in the future. Results One hundred thirty cases of cochlear implants were performed in our department between 2016 and 2018. Sixty complications were recorded, including 27 cases of minor and 21 cases of major complications. Minor complications were flap wound infection in 4 cases (3.1%), chorda tympani nerve injury in 7 cases (5.4%), postoperative vertigo and vomiting in 3 cases (2.3%), injury of EAC in 7 cases (5.4%), wound seroma/hematoma in 4 cases (3.1%), and facial nerve twitching in 2 cases (1.5%). Major complications were electrode extrusion in 2 cases (1.5%), CSOM in 1 case (0.8%), CSF leak in 8 cases (6.1%), magnet migration in 3 cases (2.3%), total facial nerve paralysis in 5 cases (3.8%), and device failure in 2 cases (1.5%). Conclusion The overall incidence of major complications is low. The majority of minor complications can be effectively managed with conservative measures. Cochlear implantation remains a safe and effective surgical procedure.

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Reconstruction of Complex Parotidectomy Defects Using the Lateral Arm Free Tissue Transfer

Otolaryngology ◽

10.1016/s0194-5998(03)00718-6 ◽

2003 ◽

Vol 129 (3) ◽

pp. 183-191 ◽

Cited By ~ 41

Author(s):

Theodoros N. Teknos ◽

Brian Nussenbaum ◽

Carol R. Bradford ◽

Mark E. Prince ◽

Hussam El-Kashlan ◽

...

Keyword(s):

Facial Nerve ◽

Donor Site ◽

Tertiary Care ◽

Case Series ◽

Facial Nerve Paralysis ◽

Complication Rates ◽

Nerve Paralysis ◽

Lateral Arm Flap ◽

The Mean ◽

Facial Clinimetric Evaluation Scale

OBJECTIVES: The study goal was to show that the lateral arm flap is a viable reconstructive option for complex parotidectomy defects. STUDY DESIGN AND SETTING: We studied a case series at a tertiary care medical center from March 1997 to March 2002. The lateral arm flap was used to reconstruct parotidectomy defects that included a composite resection of adjacent tissue in 30 patients. There were 19 men and 11 women (mean age, 62 years; mean follow-up, 19 months). The mean flap area was 114 cm2, and the mean flap volume was 172 cm3. The posterior cutaneous nerve of the forearm (PCNF) was used as a facial nerve cable graft in 14 patients. Facial disability outcomes were measured using the Facial Clinimetric Evaluation scale. RESULTS: The major and minor complication rates with use of this reconstructive approach were low: 16.7% (5 of 30) and 26.7% (8 of 30), respectively. Donor site morbidity was minimal, with no patient having a major donor site complication and 23.3% (7 of 30) having minor complications. Functional recovery of the facial nerve occurred in 6 of 8 evaluable patients who underwent facial nerve grafting using the PCNF. Controlling for degree of facial nerve paralysis, Facial Clinimetric Evaluation scale scores of our patients were not statistically different than those of a historic population with a facial paralysis and no surgical defect. CONCLUSIONS: The lateral arm free flap effectively restores facial appearance when used for reconstruction of complex parotidectomy defects. The PCNF, a nerve harvested with the lateral arm flap, can be used as a facial nerve cable graft with a high rate of success. SIGNIFICANCE: The lateral arm flap is successful as a single donor site for reconstructing facial contour and the facial nerve after major ablative defects in the parotid region.

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Delayed Facial Nerve Paralysis after Vestibular Schwannoma Resection

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633443 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Robert Yawn ◽

Matthew Dedmon ◽

Reid Thompson ◽

Matthew O'Malley ◽

Marc Bennett ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Facial Nerve Paralysis ◽

Nerve Paralysis

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Collagen Family Genes Associated with Risk of Recurrence after Radiation Therapy for Vestibular Schwannoma and Pan-Cancer Analysis

Disease Markers ◽

10.1155/2021/7897994 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Qingyuan Shi ◽

Xiaojun Yan ◽

Jiyun Wang ◽

Xiangbao Zhang

Keyword(s):

Radiation Therapy ◽

Neuropeptide Y ◽

Vestibular Schwannoma ◽

Line Graph ◽

Clinical Information ◽

High Rate ◽

Tumor Control ◽

Risk Of Recurrence ◽

First Time ◽

Pan Cancer

Background. The safety of radiotherapy techniques in the treatment of vestibular schwannoma (VS) shows a high rate of tumor control with few side effects. Neuropeptide Y (NPY) may have a potential relevance to the recurrence of VS. Further research is still needed on the key genes that determine the sensitivity of VS to radiation therapy. Materials and Methods. Transcriptional microarray data and clinical information data from VS patients were downloaded from GSE141801, and vascular-related genes associated with recurrence after radiation therapy for VS were obtained by combining information from MSigDB. Logistics regression was applied to construct a column line graph prediction model for recurrence status after radiation therapy. Pan-cancer analysis was also performed to investigate the cooccurrence of these genes in tumorigenesis. Results. We identified eight VS recurrence-related genes from the GSE141801 dataset. All of these genes were highly expressed in the VS recurrence samples. Four collagen family genes (COL5A1, COL3A1, COL4A1, and COL15A1) were further screened, and a model was constructed to predict the risk of recurrence of VS. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses revealed that these four collagen family genes play important roles in a variety of biological functions and cellular pathways. Pan-cancer analysis further revealed that the expression of these genes was significantly heterogeneous across immune phenotypes and significantly associated with immune infiltration. Finally, Neuropeptide Y (NPY) was found to be significantly and negatively correlated with the expression of COL5A1, COL3A1, and COL4A1. Conclusions. Four collagen family genes have been identified as possible predictors of recurrence after radiation therapy for VS. Pan-cancer analysis reveals potential associations between the pathogenesis of VS and other tumorigenic factors. The relevance of NPY to VS was also revealed for the first time.

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Delayed Facial Nerve Paralysis after Vestibular Schwannoma Resection

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669941 ◽

2018 ◽

Vol 80 (03) ◽

pp. 283-286

Author(s):

Robert J. Yawn ◽

Matthew M. Dedmon ◽

Deborah Xie ◽

Reid C. Thompson ◽

Matthew R. O'Malley ◽

...

Keyword(s):

Facial Nerve ◽

Surgical Resection ◽

Vestibular Schwannoma ◽

Retrospective Chart Review ◽

Facial Nerve Paralysis ◽

Nerve Function ◽

Facial Nerve Function ◽

Nerve Paralysis ◽

The Mean

Objective To describe the incidence and clinical course of patients who develop delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma. Setting Tertiary skull base center. Methods Retrospective chart review. Results Two hundred and forty six consecutive patients, who underwent surgical resection for vestibular schwannoma at a single center between 2010 and 2015, were analyzed. Of these patients, 22 (8.9%) developed DFNP, defined here as deterioration of function by at least 2 House–Brackmann (HB) grades within 30 days in patients with immediate postoperative HB ≤ 3. The mean age of DFNP patients was 47.2 years (range: 17–67) and 16 (73%) were female. The mean tumor size in greatest dimension was 2.1 cm (range: 0.7–3.5 cm). At the conclusion of each case, the facial nerve stimulated at the brainstem. Mean immediate postoperative facial nerve function was HB 1.8 (range: 1–3). Average facial nerve function at the 3-week-postoperative visit was 4.4 (range: 2–6). In 1-year, 8 patients (36%) recovered HB 1 function, 10 patients (46%) recovered to HB 2, and 2 patients (9%) were HB 3. The remaining 2 patients did not recover function and were HB 6 at last follow-up. Initial postoperative facial nerve function (HB 1 or HB 2) was associated with improved recovery to normal (HB 1) function (p = 0.018). Conclusion A majority of patients that develop delayed paralysis will recover excellent facial nerve function. Patients should be counseled; however, a small percentage of patients will not recover function long-term, despite having a previously functioning and anatomically intact nerve.

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