scholarly journals Surgical Management of Jugular Foramen Schwannomas

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4218
Author(s):  
Amir Kaywan Aftahy ◽  
Maximilian Groll ◽  
Melanie Barz ◽  
Denise Bernhardt ◽  
Stephanie E. Combs ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Nerve Palsy ◽  
Hypoglossal Nerve ◽  
Surgical Intervention ◽  
Facial Nerve Palsy ◽  
Jugular Foramen ◽  
Cerebellar Dysfunction ◽  
Total Resection ◽  
Gag Reflex

Background: Resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve (CN) injury remains difficult. Reoperations in this vital region are associated with severe CN deficits. Methods: We performed a retrospective analysis at a tertiary neurosurgical center of patients who underwent surgery for JFSs between June 2007 and May 2020. We included nine patients (median age 60 years, 77.8% female, 22.2% male). Preoperative symptoms included hearing loss (66.6%), headache (44.4%), hoarseness (33.3%), dysphagia (44.4%), hypoglossal nerve palsy (22.2%), facial nerve palsy (33.3%), extinguished gag reflex (22.2%), and cerebellar dysfunction (44.4%). We observed Type A, B, C, and D tumors in 3, 1, 1, and 4 patients, respectively. A total of 77.8% (7/9) underwent a retrosigmoid approach, and 33.3% (3/9) underwent an extreme lateral infrajugular transcondylar (ELITE) approach. Gross total resection (GTR) was achieved in all cases. The rate of shunt-dependent hydrocephalus was 22.2% (2/9). No further complications requiring surgical intervention occurred during follow-up. The median follow-up time was 16.5 months (range 3–84 months). Conclusions: Considering the satisfying outcome, the GTR of JFSs is feasible in performing well-known skull base approaches. Additional invasive and complicated approaches were not needed. Radiosurgery may be an effective alternative for selected patients.

Double Intratemporal Congenital Cholesteatomas Combined with Ossicular Anomalies

1986 ◽  
Vol 95 (4) ◽  
pp. 401-403 ◽  
Author(s):  
Tsun-Sheng Huang
Keyword(s):  
Hearing Loss ◽  
Early Detection ◽  
Temporal Bone ◽  
Nerve Palsy ◽  
Surgical Intervention ◽  
Facial Nerve Palsy ◽  
Conductive Hearing Loss ◽  
The Other ◽  
Presenting Symptoms ◽  
Conductive Hearing

A 15-year-old patient had unilateral double congenital cholesteatomas, one isolated to the mastoid and the other located in the petrous pyramid. The presenting symptoms were facial palsy and a conductive hearing loss on the affected side. The case is interesting, not only in that there were two isolated cholesteatomas in the same temporal bone, but also because of the combination of ossicular anomalies. The unusually early detection and surgical intervention in this instance suggest that similar cases of multicentric cholesteatomas may have occurred, but may have been concealed because of the later detection and possible linkage of the cholesteatomas. I would therefore emphasize Sheehy's recommendation that temporal bone radiography never be omitted where idiopathic facial nerve palsy exists.

scholarly journals Hypoglossal-Facial Anastomosis for Facial Nerve Reconstruction: Outcomes using the Side-to-End Surgical Technique

2020 ◽  
Author(s):  
Leonardo Gilmone Ruschel ◽  
Joel Sanabria Duarte ◽  
Jonathan De La Cruz ◽  
Kristel Back Merida ◽  
Gustavo Fabiano Nogueira ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Nerve Palsy ◽  
Hypoglossal Nerve ◽  
Facial Nerve Palsy ◽  
Nerve Transection ◽  
Nerve Reconstruction ◽  
Posterior Fossa Tumors ◽  
Swallowing Problems ◽  
Facial Nerve Reconstruction

Abstract Introduction The side-to-end hypoglossal-facial anastomosis (HFA) technique is an excellent alternative technique to the classic end-terminal anastomosis, because it may decrease the symptoms resulting from hypoglossal-nerve transection. Methods Patients with facial nerve palsy (House-Brackmann [HB] grade VI) requiring facial reconstruction from 2014 to 2017were retrospectively included in the study. Results In total, 12 cases were identified, with a mean follow-up of 3 years. The causes of facial paralysis were due to resection of posterior-fossa tumors and trauma. There was improvement in 91.6% of the patients (11/12) after the HFA. The rate of improvement according to the HB grade was as follows: HB III - 58.3%; HB IV - 16.6%; and HB II - 16.6%. The first signs of improvement were observed in the patients with the shortest time between the paralysis and the anastomosis surgery (3.5 months versus 8.5 months; p = 0.011). The patients with HB II and III had a shorter time between the diagnosis and the anastomosis surgery (mean: 5.22 months), while the patients with HB IV and VI had a longer time of paresis (mean: 9.5 months; p = 0.099). We did not observe lingual atrophy or changes in swallowing. Discussion and Conclusion Hypoglossal-facial anastomosis with the terminolateral technique has good results and low morbidity in relation to tongue motility and swallowing problems. The HB grade and recovery appear to be better in patients operated on with a shorter paralysis time.

scholarly journals Intracranial nonvestibular neurinomas: Young neurosurgeons’ experience

2014 ◽  
Vol 05 (03) ◽  
pp. 231-243
Author(s):  
Forhad Hossain Chowdhury ◽  
Mohammod R. Haque ◽  
Khandkar A. Kawsar ◽  
Mainul H. Sarker ◽  
Mahmudul Hasan ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Craniovertebral Junction ◽  
Jugular Foramen ◽  
Clinical Profile ◽  
Clinical Feature ◽  
Subtotal Resection ◽  
Total Resection

ABSTRACT Background and Objectives: Neurinoma arising from other than nonvestibular cranial nerves is less prevalent. Here we present our experiences regarding the clinical profile, investigations, microneurosurgical management, and the outcome of nonvestibular cranial nerve neurinomas. Materials and Methods: From January 2005 to December 2011, the recorded documents of operated nonvestibular intracranial neurinomas were retrospectively studied for clinical profile, investigations, microneurosurgical management, complications, follow-up, and outcomes. Results: The average follow-up was 24.5 months. Total number of cases was 30, with age ranging from 9 to 60 years. Sixteen cases were males and 14 were females. Nonvestibular cranial nerve schwannomas most commonly originated from trigeminal nerve followed by glossopharyngeal+/vagus nerve. There were three abducent nerve schwannomas that are very rare. There was no trochlear nerve schwannoma. Two glossopharyngeal+/vagus nerve schwannomas extended into the neck through jugular foramen and one extended into the upper cervical spinal canal. Involved nerve dysfunction was a common clinical feature except in trigeminal neurinomas where facial pain was a common feature. Aiming for no new neurodeficit, total resection of the tumor was done in 24 cases, and near-total resection or gross total resection or subtotal resection was done in 6 cases. Preoperative symptoms improved or disappeared in 25 cases. New persistent deficit occurred in 3 cases. Two patients died postoperatively. There was no recurrence of tumor till the last follow-up. Conclusion: Nonvestibular schwannomas are far less common, but curable benign lesions. Surgical approach to the skull base and craniovertebral junction is a often complex and lengthy procedure associated with chances of significant morbidity. But early diagnosis, proper investigations, and evaluation, along with appropriate decision making and surgical planning with microsurgical techniques are the essential factors that can result in optimum outcome.

Hearing loss

2018 ◽  
Author(s):  
James Ramsden
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Middle Ear ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Conductive Hearing Loss ◽  
Ear Canal ◽  
Eighth Cranial Nerve ◽  
Conductive Hearing

Hearing loss must be divided into conductive hearing loss (CHL) and sensorineural hearing loss (SNHL). CHL is caused by sound not reaching the cochlear (abnormality of the ear canal, tympanic membrane, middle ear, or ossicles), whereas SNHL is a condition affecting the cochlear or auditory (eighth cranial) nerve. Hearing loss may be accompanied by other cardinal signs of ear disease, such as pain or discharge from the ear, vertigo, facial nerve palsy, and tinnitus, which guide the diagnosis. This chapter describes the approach to the patient with hearing loss.

Potential association between recurrent facial nerve palsy and migraines

2020 ◽  
Vol 134 (9) ◽  
pp. 822-825
Author(s):  
G Kontorinis ◽  
A Tyagi
Keyword(s):  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Case Series ◽  
Contralateral Side ◽  
Tertiary Referral Centre ◽  
Potential Association ◽  
Motor Neuron Facial Nerve ◽  
Prospective Case Series

AbstractObjectiveThis study aimed to investigate the possible association between recurrent facial nerve palsy and migraines.MethodThis study was a prospective case series with a two-year follow-up at an academic, tertiary referral centre and included patients with at least four episodes of recurrent lower motor neuron facial nerve palsy. All patients underwent standardised diagnostic tests.ResultsFour patients fulfilled the inclusion criteria. The patients were all female with an average age at presentation of 40.75 years (range, 33–60 years) and an average age at the initial episode of 14 years (range, 12–16 years). The number of episodes varied between six and nine. All patients had at least one episode of facial nerve palsy on the contralateral side. Two patients were diagnosed and treated for migraine with aura remaining asymptomatic following prophylactic medication for migraines.ConclusionThe results raise the possibility of an association between recurrent facial nerve palsy and migraines. Prospective studies in patients with even fewer episodes of facial nerve palsy could shed more light on this association.

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.

scholarly journals Hypoglossal Nerve Palsy As an Initial Presentation of Glomus Jugulare Tumor in Patient with Breast Cancer: A Case Report and Literature Review

2021 ◽  
Vol 10 ◽  
pp. e2222
Author(s):  
Askar Ghorbani ◽  
Vahid Reza Ostovan
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Nerve Palsy ◽  
Hypoglossal Nerve ◽  
Clinical Manifestations ◽  
Glomus Jugulare Tumor ◽  
Hypoglossal Nerve Palsy ◽  
Glomus Jugulare ◽  
Work Up

Background: Glomus jugulare tumor is a rare, slow-growing, hyper-vascular paraganglioma that originates from the neural crest derivatives in the wall of the jugular bulb. The most common clinical manifestations of glomus jugulare are pulsatile tinnitus, conductive hearing loss, and hoarseness due to its vascularity and invasion of surrounding structures. Isolated hypoglossal nerve palsy as a presenting feature of the glomus jugulare is very rare. Case Report: We report a 61-year-old woman with a past medical history of breast cancer and diabetic mellitus presenting with progressive difficulty handling food in her mouth and tongue atrophy. Investigations showed skull base lesion and solitary pulmonary nodule. Further work-up led to glomus jugulare and benign solitary pulmonary fibrous tumor diagnosis, although the first impression was metastatic involvement of the jugular foramen. Endovascular embolization of the glomus jugulare was performed, but the patient refused any open surgery due to co-morbidities and the risk of operation. She had no new symptoms at the one-year follow-up, and the size of the lesion became more minor on the follow-up imaging relative to the baseline. Conclusion: Glomus jugulare tumors should be considered and surveyed in the diagnostic work-up of patients with hypoglossal nerve palsy. [GMJ.2021;10:e2222]

scholarly journals Nervus intermedius dysfunctions after vestibular schwannoma surgery: a prospective clinical study

2019 ◽  
Vol 131 (2) ◽  
pp. 555-560 ◽  
Author(s):  
Hussam Metwali ◽  
Katja Kniese ◽  
Babak Kardavani ◽  
Venelin Gerganov ◽  
Madjid Samii
Keyword(s):  
Facial Nerve ◽  
Prospective Study ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Nasal Secretion ◽  
Prospective Clinical Study ◽  
Taste Sensation ◽  
Nervus Intermedius

OBJECTIVEThe purpose of this prospective study was to evaluate the dysfunction of the nervus intermedius (NI) after vestibular schwannoma (VS) surgery. The authors present a clinically feasible method for this purpose.METHODSIn this prospective study, the authors included 30 patients who underwent surgery at the International Neuroscience Institute between May 2014 and February 2017 for resection of VS. The patients’ taste sensation was examined using taste strips. Lacrimation was tested using the Schirmer I test. The clinical evaluation was performed before surgery and repeated at 2 weeks and at 6 months after surgery as well as during the follow-up, which extended up to 2 years. The authors tested the correlation between the NI dysfunctions and the House-Brackmann grade of facial nerve palsy.RESULTSThe taste sensation was lost on the side of surgery in 2 patients (6.6%) and decreased in 4 patients (13.3%). The disturbance of taste sensation was not statistically correlated with dysfunctions of the motor portion of the facial nerve. The taste impairment resolved in 4 patients within 6 months, but 2 patients suffered from persistent loss of the taste sensation on the side of surgery during the follow-up. In 23 patients (76.6%), the baseline lacrimation was lower on the side of surgery, and it was significantly correlated with outcome for dysfunctions of the motor portion of the facial nerve. During the follow-up, baseline lacrimation improved in correlation with the improvement in the dysfunctions of the motor portion of the facial nerve. None of the patients reported change in salivation or nasal secretion.CONCLUSIONSThe NI can be affected after VS surgery. The disturbance of baseline lacrimal secretion was correlated with dysfunctions of the motor portion of the facial nerve. However, the disturbance of the taste sensation was not correlated with the grade of facial nerve palsy. Dysfunctions of the NI should be evaluated and separately reported while analyzing facial nerve outcome after VS surgery.

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