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.

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).

Facial nerve repair accomplished by the interposition of a collagen nerve guide

2000 ◽  
Vol 93 (1) ◽  
pp. 113-120 ◽  
Author(s):  
Américo Kiyoshi Kitahara ◽  
Yoshihiko Nishimura ◽  
Yasuhiko Shimizu ◽  
Katsuaki Endo
Keyword(s):  
Horseradish Peroxidase ◽  
Facial Nerve ◽  
Electrophysiological Study ◽  
Nerve Repair ◽  
The Other ◽  
Great Promise ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Content Type ◽  
Fine Print

Object. Facial nerve paralysis due to a surgical procedure or trauma is a frequently observed complication. The authors evaluated facial nerve repair achieved by the interposition of a collagen nerve guide.Methods. Ten cats were divided into three groups. Group 1 consisted of six animals in which a 5-mm facial nerve segment on one side was resected and replaced by a collagen tube that was sutured to bridge both nerve stumps. On the opposite side a 5-mm segment of facial nerve was resected, reversed 180°, and sutured to the stumps as an autograft nerve. Group 2 consisted of two cats in which the collagen nerve guide was interposed on one side and the nerve on the other side was left intact. Group 3 consisted of two cats in which a reversed autograft nerve was placed on one side and the nerve on the other side was left intact. Histological, electrophysiological, and horseradish peroxidase labeling examinations were performed starting 3 weeks after surgery.Light and electron microscopic examinations of collagen tube—implanted specimens revealed a well-vascularized regenerated nerve. The electrophysiological study confirmed the recovery of electrical activity in regenerated axons. Horseradish peroxidase labeling also confirmed restoration of the whole facial nerve tract.Conclusions. The collagen nerve guide shows great promise as a nerve conduit.

Intracanalicular vestibular schwannomas presenting with facial nerve paralysis

2018 ◽  
Vol 160 (4) ◽  
pp. 689-693 ◽  
Author(s):  
Luciano Mastronardi ◽  
Guglielmo Cacciotti ◽  
Raffaele Roperto
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis

Method of eyelid closure in facial nerve paralysis

1982 ◽  
Vol 57 (5) ◽  
pp. 722-723 ◽  
Author(s):  
Ephraim I. Zlotnik ◽  
Arnold F. Smeyanovich ◽  
Eugene P. Tyappo
Keyword(s):  
Facial Nerve Paralysis ◽  
Total Removal ◽  
Nerve Paralysis ◽  
Content Type ◽  
Eyelid Closure ◽  
Prevention And Treatment ◽  
Acoustic Neurinomas ◽  
Conjunctival Inflammation ◽  
Subcutaneous Connective Tissue ◽  
Fine Print

✓ The authors present a method of temporary eyelid closure consisting of air inflation of the subcutaneous connective tissue. This method is effective for prevention and treatment of conjunctival inflammation due to facial paralysis developing after total removal of acoustic neurinomas.

Synovial chondromatosis of the temporomandibular joint with intracranial extension

1989 ◽  
Vol 70 (1) ◽  
pp. 121-123 ◽  
Author(s):  
C. Phillip Daspit ◽  
Robert F. Spetzler
Keyword(s):  
Facial Nerve ◽  
Temporomandibular Joint ◽  
Fine Needle Biopsy ◽  
Synovial Chondromatosis ◽  
Intracranial Extension ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Content Type ◽  
Nerve Dysfunction ◽  
Peripheral Facial Nerve Paralysis

✓ The authors report the unusual presentation of an intracranial extension of synovial chondromatosis of the temporomandibular joint. The patient presented with a peripheral facial nerve paralysis and anacusis. Computerized tomography revealed the lesion, but fine-needle biopsy was inconclusive. Craniotomy with removal of the tumor was performed, and pathological studies confirmed the diagnosis. The facial nerve dysfunction was thought to be secondary to direct neural compression.

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