Facial nerve preservation during surgery for removal of acoustic nerve tumors

1982 ◽  
Vol 57 (6) ◽  
pp. 739-746 ◽  
Author(s):  
Richard H. Lye ◽  
John Dutton ◽  
Richard T. Ramsden ◽  
Joseph V. Occleshaw ◽  
Iain T. Ferguson ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Petrous Bone ◽  
Ct Scans ◽  
Facial Weakness ◽  
Content Type ◽  
Nerve Preservation ◽  
Increased Risk ◽  
Acoustic Nerve ◽  
Facial Function ◽  
Fine Print

✓ A series of 33 patients with 35 acoustic nerve tumors is reviewed. Tumor size was estimated from computerized tomography (CT) scans, and its influence on anatomical and functional preservation of the facial nerve was assessed. Six tumors (one invading the petrous bone, three medium and two large tumors) were not detected on CT scans. The translabyrinthine approach was used in seven instances (one small and six medium tumors) and the suboccipital transmeatal approach for 28 tumors (seven medium and 21 large tumors). Anatomical preservation of the facial nerve was achieved in 83% of operations for tumor removal, two of which were subtotal. A further two patients underwent subtotal removal, but the facial nerve was destroyed. Large tumors carried an increased risk of damage to the facial nerve, but even in this group the nerve was preserved anatomically intact in 70% of cases. Damage to the facial nerve occurred more frequently in patients with preoperative evidence of facial weakness; however, this factor did not appear to influence functional recovery of the facial nerve, provided that the nerve was intact at the end of the operation. A simple grading system for facial nerve function is described. Only 76% of anatomically intact facial nerves showed any evidence of function 1 month after surgery. Postoperatively, facial function improved with time. At the latest review, 45% of these patients had normal facial function or mild facial weakness (Grades I and II).

Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome

2005 ◽  
Vol 102 (4) ◽  
pp. 643-649 ◽  
Author(s):  
Douglas E. Anderson ◽  
John Leonetti ◽  
Joshua J. Wind ◽  
Denise Cribari ◽  
Karen Fahey
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Nerve Monitoring ◽  
Content Type ◽  
Nerve Preservation ◽  
Facial Nerve Monitoring ◽  
Facial Function ◽  
Fine Print

Object. Vestibular schwannoma surgery has evolved as new therapeutic options have emerged, patients' expectations have risen, and the psychological effect of facial nerve paralysis has been studied. For large vestibular schwannomas for which extirpation is the primary therapy, the goals remain complete tumor resection and maintenance of normal neurological function. Improved microsurgical techniques and intraoperative facial nerve monitoring have decreased the complication rate and increased the likelihood of normal to near-normal postoperative facial function. Nevertheless, the impairment most frequently reported by patients as an adverse effect of surgery continues to be facial nerve paralysis. In addition, patient assessment has provided a different, less optimistic view of outcome. The authors evaluated the extent of facial function, timing of facial nerve recovery, patients' perceptions of this recovery and function, and the prognostic value of intraoperative facial nerve monitoring following resection of large vestibular schwannomas; they then analyzed these results with respect to different surgical approaches. Methods. The authors retrospectively reviewed a database of 67 patients with 71 vestibular schwannomas measuring 3 cm or larger in diameter. The patients had undergone surgery via translabyrinthine, retrosigmoid, or combined approaches. Clinical outcomes were analyzed with respect to intraoperative facial nerve activity, responses to intraoperative stimulation, and time course of recovery. Eighty percent of patients obtained normal to near-normal facial function (House—Brackmann Grades I and II). Patients' perceptions of facial nerve function and recovery correlated well with the clinical observations. Conclusions. Trends in the data lead the authors to suggest that a retrosigmoid exposure, alone or in combination with a translabyrinthine approach, offers the best chance of facial nerve preservation in patients with large vestibular schwannomas.

En bloc petrosectomy using a Gigli saw for petroclival lesions

1995 ◽  
Vol 83 (3) ◽  
pp. 559-560 ◽  
Author(s):  
Tomio Sasaki ◽  
Makoto Taniguchi ◽  
Ichiro Suzuki ◽  
Takaaki Kirino
Keyword(s):  
Facial Nerve ◽  
Semicircular Canals ◽  
Petrous Bone ◽  
New Technique ◽  
En Bloc ◽  
Content Type ◽  
A New Technique ◽  
Transtentorial Approach ◽  
Fine Print

✓ The authors report a new technique for en bloc petrosectomy using a Gigli saw as an alternative to drilling the petrous bone in the combined supra- and infratentorial approach or the transpetrosal—transtentorial approach. It is simple and easy and avoids postoperative cosmetic deformity. This technique has been performed in 11 petroclival lesions without injuring the semicircular canals, the cochlea, or the facial nerve.

Posterior petrous meningiomas: 82 cases

2005 ◽  
Vol 102 (2) ◽  
pp. 284-289 ◽  
Author(s):  
Zhe Bao Wu ◽  
Chun Jiang Yu ◽  
Shu Sen Guan
Keyword(s):  
Facial Nerve ◽  
Clinical Manifestations ◽  
Petrous Bone ◽  
Type I ◽  
Type Ii ◽  
Posterior Surface ◽  
Total Resection ◽  
Content Type ◽  
Functional Preservation ◽  
Fine Print

Object. The aim of this study was to discuss posterior petrous meningiomas—their classification, clinical manifestations, surgical treatments, and patient outcomes. Methods. A retrospective analysis was performed in 82 patients with posterior petrous meningiomas for microsurgery. According to the anatomical relationship with the posterior surface of the petrous bone and with special reference to the internal auditory canal (IAC), posterior petrous meningiomas were classified into three types: Type I, located laterally to the IAC (28 cases); Type II, located medially to the IAC, which might extend to the cavernous sinus and clivus (32 cases); and Type III, extensively attached to the posterior surface of the petrous bone, which might envelop the seventh and eighth cranial nerves (22 cases). Sixty-eight (83%) of 82 cases involved total resection. The rate of anatomical preservation of facial nerve was 97.5%, whereas the functional preservation rate was 81%. The rate of hearing preservation was 67%. All Type I tumors were completely resected, and the rate of anatomical preservation of facial nerve was 100% and functional preservation was 93%. Regarding Type II lesions, 75% of 32 cases involved total resection; the rate of anatomical preservation of facial nerve was 97% and functional preservation was 75%. For Type III lesions, 73% of 22 cases were totally resected. The rate of anatomical preservation of facial nerve in patients with this tumor type was 95%, whereas functional preservation was 73%. Conclusions. Clinical manifestations and surgical prognoses are different among the various types of posterior petrous meningiomas. It is more difficult for Types II and III tumors to be resected radically than Type I lesions, and postoperative functional outcomes are significantly worse accordingly. The primary principles in dealing with this disease entity include preservation of vital vascular and central nervous system structures and total resection of the tumor as much as possible.

Neurinomas of the facial nerve

1975 ◽  
Vol 43 (5) ◽  
pp. 608-613 ◽  
Author(s):  
Fabian Isamat ◽  
Federico Bartumeus ◽  
Antonio M. Miranda ◽  
Jaime Prat ◽  
Luis C. Pons
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Petrous Bone ◽  
The Other ◽  
Bone Area ◽  
Content Type ◽  
Fine Print

✓ Three cases of neurinomas of the facial nerve are reported. Two of them originated from the labyrinthine portion of the nerve and the other from the vertical portion. Neurinomas of the first part of the facial nerve can be suspected preoperatively since they seem to give rise to specific clinical and radiological manifestations that can be distinguished from tumors of other portions of the nerve, the petrous bone area, or the cerebellopontine angle. The reported cases of neurinomas of the facial nerve are reviewed and analyzed.

Percutaneous radiofrequency facial nerve coagulation in the management of facial spasm

1981 ◽  
Vol 54 (5) ◽  
pp. 655-658 ◽  
Author(s):  
Tomokatsu Hori ◽  
Takanori Fukushima ◽  
Hideo Terao ◽  
Kintomo Takakura ◽  
Keiji Sano
Keyword(s):  
Facial Nerve ◽  
Age Of Onset ◽  
Facial Weakness ◽  
Content Type ◽  
Operative Results ◽  
Stylomastoid Foramen ◽  
Blunt Needle ◽  
Facial Spasm ◽  
Fine Print

✓ The authors have developed a fluoroscopy-assisted technique of percutaneous radiofrequency facial nerve coagulation at or near the stylomastoid foramen for management of facial spasm. The details of the procedure and the operative results in the initial series of 27 cases of facial spasm are described. The series included six men and 21 women, aged from 16 to 73 years. Twenty-four patients had classical, intractable, persistent hemifacial spasm, one had an unusual bilateral facial spasm, and one a postparalytic facial spasm. The age of onset varied from 16 years to 70 years. The duration of the symptoms ranged from 3 months to 11 years. Ten patients had undergone previous blunt-needle compression of the facial nerve from one to 10 times. The operative results in the 27 patients have so far been excellent. The longest follow-up has been 1½ years. Although partial facial weakness was present in 60% of the cases, it invariably disappeared within 1 to 4 months. Only three patients experienced recurrence of spasm. In two of them, recurrence followed lowtemperature coagulation. The procedure is simple, easy to perform, and extremely effective. It can be performed under local anesthesia in the outpatient clinic.

Blood transfusion and increased risk for vasospasm and poor outcome after subarachnoid hemorrhage

2004 ◽  
Vol 101 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Michelle J. Smith ◽  
Peter D. Le Roux ◽  
J. Paul Elliott ◽  
H. Richard Winn
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Blood Transfusion ◽  
Smoking Status ◽  
Ct Scans ◽  
Content Type ◽  
Poor Outcome ◽  
Increased Risk ◽  
Confounding Variables ◽  
Rbc Transfusion ◽  
Fine Print

Object. Nitric oxide (NO) metabolism may influence vasospasm after subarachnoid hemorrhage (SAH). It has been demonstrated in recent studies that erythrocytes carry NO for release in vessels, whereas transfused erythrocytes may lack stored NO. Several converging lines of evidence also indicate that blood transfusion may exacerbate poor outcomes in some critically ill patients. In this study the authors hypothesized that patients with SAH who received red blood cell (RBC) transfusions were at greater risk for vasospasm and poor outcome. Methods. The authors retrospectively reviewed a prospective observational database, including hospital records, computerized tomography (CT) scans, and pre- and postoperative four-vessel angiograms, in which the management methods used in 441 patients undergoing surgery for ruptured cerebral aneurysms were described. Two hundred seventy patients (61.2%) received an RBC transfusion during their hospital stay. After adjustment for Hunt and Hess grade, SAH grade on CT scans, delay between rupture and surgery, smoking status, and intraoperative aneurysm rupture, a worse outcome was more likely in patients who received intraoperative blood (odds ratio [OR] 2.44, confidence interval [CI] 1.32–4.52; 120 patients). Intraoperative RBC transfusion did not influence subsequent angiographically confirmed vasospasm (OR 0.92, CI 0.6–1.4). Worse outcome was observed in patients who received blood postoperatively (OR 1.81, CI 1.21–2.7), but not after adjustments were made for confounding variables (OR 1.48, CI 0.83–2.63). Angiographic vasospasm was observed in 217 patients and, after adjusting for confounding variables, was more frequent among patients who received postoperative RBC transfusion (OR 1.68, CI 1.02–2.75). Among patients in whom angiographically confirmed vasospasm developed there was a tendency to have received more blood than in those with no vasospasm; however, a clear dose-dependent response was not observed. Conclusions. Development of angiographically confirmed vasospasm after SAH is associated with postoperative RBC transfusion and worse outcome is associated with intraoperative RBC transfusion. Before blood is transfused, patients with SAH should be carefully assessed to determine if they are symptomatic because of anemia.

Primary facial nerve tumors within the skull

1990 ◽  
Vol 72 (1) ◽  
pp. 1-8 ◽  
Author(s):  
T. T. King ◽  
A. W. Morrison
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Nerve Repair ◽  
Petrous Bone ◽  
Surgical Removal ◽  
Content Type ◽  
Radiological Features ◽  
Acoustic Nerve ◽  
Relationship Of ◽  
Characteristic Relationship

✓ In a series of 527 cerebellopontine angle tumors, there were 416 cases of acoustic nerve tumors and 14 cases of primary tumor of the facial nerve in the petrous bone or intracranial cavity. Six additional patients were presumed to have facial tumors, although they were not operated on. Of the 14 verified facial nerve tumors, all but two were neurinomas and 11 had important intracranial extensions into the middle and/or the posterior fossa. In most of these 14 cases, surgical removal was performed via the translabyrinthine route, which is advantageous in that it displays the characteristic relationship of the tumor to the facial nerve, and facilitates nerve repair. The clinical and radiological features of these facial nerve lesions are discussed and also the indications for surgical treatment which, as the unoperated cases illustrate, is not always necessary.

Long-term results of spinal accessory nerve-facial nerve anastomosis

1992 ◽  
Vol 77 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Michael J. Ebersold ◽  
Lynn M. Quast
Keyword(s):  
Facial Nerve ◽  
Functional Disability ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Long Term Results ◽  
Content Type ◽  
Spinal Accessory ◽  
Nerve Anastomosis ◽  
Facial Function ◽  
Fine Print

✓ A number of methods have been developed to reduce the cosmetic and functional disability resulting from facial nerve loss. It has often been suggested that the major trunk of the spinal accessory nerve should not be sacrificed for providing dynamic facial function because of shoulder disability and pain. A review of Mayo Clinic records has revealed that, between the years of 1975 and 1983, 25 patients underwent spinal accessory nerve-facial nerve anastomosis using the major division (branch to the trapezius muscle) of the spinal accessory nerve. There were 11 males and 14 females, ranging in age from 16 to 60 years (mean 41 years). The interval between facial nerve loss and anastomosis was 1 week to 34 months (mean 4.62 months). The duration of follow-up study ranged from 7 to 15 years (mean 10.8 years). Twenty patients had no complaints or symptoms related to their shoulder or arm at the time of this review and no patient had significant shoulder morbidity. The facial function achieved was “minimal” in five cases, “moderate” in six, and good to excellent in 14. Most patients appeared to benefit significantly from the spinal accessory nerve-facial nerve anastomosis. The morbidity of the procedure seemed quite minimal even in the young and active. The authors continue to believe that the spinal accessory nerve-facial nerve anastomosis, even when using the major trunk of the spinal accessory nerve, is a very useful and beneficial procedure.

Translabyrinthine and transtentorial removal of acoustic nerve tumors

1980 ◽  
Vol 52 (2) ◽  
pp. 210-216 ◽  
Author(s):  
T. T. King ◽  
A. W. Morrison
Keyword(s):  
Facial Nerve ◽  
Content Type ◽  
Acoustic Nerve ◽  
Fine Print

✓ The translabyrinthine route or an extension of it was used to remove 150 acoustic nerve tumors. The mortality was 2% and the morbidity low. Preservation of the facial nerve was achieved in 100% of the small and 80% of the medium-sized tumors, but in only 20% of the large growths. The complications encountered are discussed.

Preservation of facial function during removal of acoustic neuromas

1984 ◽  
Vol 61 (4) ◽  
pp. 757-760 ◽  
Author(s):  
Aage R. Møller ◽  
Peter J. Jannetta
Keyword(s):  
Facial Nerve ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Content Type ◽  
Acoustic Neuromas ◽  
Internal Impedance ◽  
Monopolar Stimulation ◽  
Stimulation Technique ◽  
Facial Function ◽  
Fine Print

✓ The authors describe a modification in the way the facial nerve is stimulated electrically during operations to remove medium and large-sized (> 2 cm) acoustic tumors. This consists of monopolar stimulation with low internal impedance. Proper use of this modified stimulation technique together with acoustic monitoring of the electromyographic responses of facial muscles helps to preserve facial nerve function in patients undergoing these operations, and also decreases the duration of the operation.

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