Cranial Nerves: Trigeminal and Facial Nerve

Evidence is presented from data covering the period 1940 to 1952 which corroborates the conclusion of previous studies that prior tonsillectomy probably adversely affects the occurrence of brainstem paralysis (bulbar and bulbospinal) in poliomyelitis. Neither this study nor any preceding studies relating to this problem have proved the contention. On the basis that the hypothesis is correct, an attempt is made to find an answer by studying the incidence of the common paralysis of cranial nerves (VII, IX and X and XI) in bulbar and bulbospinal cases of poliomyelitis on the basis of presence or absence of tonsils. Rates of incidence of paralysis of cranial nerves, not adjusted for age, indicate a decidedly higher proportion of paralysis of the facial nerve (VII) among nontonsillectomized patients whereas tonsillectomized persons are preportionately more affected by palatal and pharyngeal paralysis (nerves IX and X). Paralysis of the facial nerve appears from two studies to occur more commonly at earlier ages, particularly in the age group 0 to 4 years. However, age adjustment did not erase, although it did somewhat lower, the TR/TP ratio. This finding lends credence to a real difference but can only be applied to this study, as Paffenbarger in a smaller study found no significant difference in frequencies of paralysis of the facial nerve between groups with tonsils removed and tonsils present, and Southcott, also in a small study, found paralysis of the facial nerve more common among tonsillectomized patients with bulbar (includes bulbospinal) involvement. The differences noted for palatal and pharyngeal paralyses (nerves IX and X) in the unadjusted rates as between tonsillectomized and nontonsillectomized patients remain statistically different and in some instances significant when corrections for age are made. The results of this study are suggestive but give no entirely satisfactory explanation for the differences noted. Various explanations previously offered are cited and briefly discussed. Perhaps more definitive studies in animals along the approach suggested by Southcott will prove more fruitful, namely, labelling virus by some radioactive element in order to trace the route it takes to the central nervous system.

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EFFECTS OF USING COMBINED TRANSPETROSAL SURGICAL APPROACHES TO TREAT PETROCLIVAL MENINGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000255476.06247.f1 ◽

2007 ◽

Vol 60 (6) ◽

pp. 982-992 ◽

Cited By ~ 44

Author(s):

Tiit Mathiesen ◽

Åsa Gerlich ◽

Lars Kihlström ◽

Mikael Svensson ◽

Dan Bagger-Sjöbäck

Keyword(s):

Facial Nerve ◽

Psychosocial Support ◽

Cranial Nerves ◽

Negative Influence ◽

Surgical Approaches ◽

Tumor Control ◽

Recurrence Rates ◽

Trigeminal Neuropathy ◽

Mean Values ◽

Petroclival Meningiomas

Abstract OBJECTIVE Surgical treatment may be required for large petroclival meningiomas; however, surgery for these lesions is a major undertaking, and modern surgical approaches are still associated with considerable morbidity and recurrence rates. We analyzed our series of transpetrosally operated petroclival meningiomas to obtain detailed information regarding the surgery outcomes with respect to facial nerve effects, hearing changes, general neurological and psychosocial differences, and recurrence rates to identify opportunities for improvement. METHODS Between 1994 and 2004, we used transpetrosal approaches to operate on 29 patients for petroclival meningiomas larger than 30 mm. All patients were analyzed in detail regarding neurological outcomes and hearing abilities after surgery. Swedish-speaking patients were contacted for a psychosocial follow-up evaluation using the short-item 36 (SF-36) form. Results After surgery, the Glasgow Outcome Score improved in 14 patients, was unchanged in 11 patients, and worsened in four patients. Facial nerve function was found to be of House-Brackmann Grade 3 or worse in six patients (including three individuals with transcochlear surgery and facial nerve rerouting). Of the 23 patients who underwent hearing-preservation surgery, serviceable hearing was preserved in 17 individuals. Nineteen Swedish patients were contacted for psychosocial evaluation. Three patients could not participate for health reasons; of the remaining 16 patients, 12 reported physical health scores that were below mean values for the general population. For patients who did not experience very serious neurological compromise, we found that unexpected painful trigeminal neuropathy and unilateral swallowing difficulties conveyed a negative influence on health. Three years after surgery, the patients reported more normalized health scores. CONCLUSION Generally, outcomes compared well with current reports. Outcomes can be improved, however by improving patients' psychosocial support; striving to decompress, preserve, and minimize dissection of ill-defined planes of cranial nerves; and using Simpson Grade 4 gamma knife approaches when radicality is precluded. Currently, the performance of transpetrosal surgery for petroclival meningiomas is a major undertaking that significantly affects a patient's health for several years; however, the approaches that we used allowed a high degree of tumor control with relatively little neurological morbidity.

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Bilateral facial nerve involvement in a patient with Tolosa–Hunt syndrome

The Neuroradiology Journal ◽

10.1177/1971400920939293 ◽

2020 ◽

Vol 33 (5) ◽

pp. 424-427

Author(s):

Ajay A Madhavan ◽

David R DeLone ◽

Jared T Verdoorn

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Cranial Nerves ◽

Corticosteroid Treatment ◽

Resonance Imaging ◽

Hunt Syndrome ◽

Facial Nerves

Tolosa–Hunt syndrome is characterized by unilateral retro-orbital headaches and cranial nerve palsies, usually involving cranial nerves III–VI. It is rare for other cranial nerves to be involved, although this has previously been reported. We report a 19-year-old woman presenting with typical features of Tolosa–Hunt syndrome but ultimately developing bilateral facial nerve palsies and enhancement of both facial nerves on magnetic resonance imaging. The patient presented with unilateral retro-orbital headaches and palsies of cranial nerves III–VI. She was diagnosed with Tolosa–Hunt syndrome but was non-compliant with her corticosteroid treatment due to side effects. She returned with progressive left followed by right facial nerve palsy. Her corresponding follow-up magnetic resonance imaging scans showed sequential enhancement of the left and right facial nerves. She ultimately had clinical improvement with IV methylprednisolone. To our knowledge, Tolosa–Hunt syndrome associated with bilateral facial nerve palsy and corroborative facial nerve enhancement on magnetic resonance imaging has not previously been described. Moreover, our patient’s clinical course is instructive, as it demonstrates that this atypical presentation of Tolosa–Hunt syndrome can indeed respond to corticosteroid treatment and should not be mistaken for other entities such as Bell’s palsy.

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Transtemporal Approach to the Skull Base: An Anatomical Study

Neurosurgery ◽

10.1227/00006123-198611000-00014 ◽

1986 ◽

Vol 19 (5) ◽

pp. 799-808 ◽

Cited By ~ 64

Author(s):

N. Sekhar Laligam ◽

Estonillo Rodrigo

Keyword(s):

Facial Nerve ◽

Vertebral Artery ◽

Skull Base ◽

Medial Temporal Lobe ◽

Case Reports ◽

Cranial Nerves ◽

Sigmoid Sinus ◽

Anterior Surface ◽

Advantages And Disadvantages ◽

Dural Opening

Abstract The surgical anatomy of a transtemporal approach to the structures of the clivus was defined with the aid of dissections in 10 cadaver heads. The steps in the dissection consisted of first exposing the cervical internal carotid artery (ICA), the internal jugular vein, and the caudal cranial nerves, each at the skull base; then performing small retromastoid and temporal craniotomies; and, finally, drilling away the petrous and tympanic bone to expose the intratemporal parts of the facial nerve, the petrous ICA, the sigmoid sinus, and the jugular bulb. To expose the structures of the lower clivus, the sigmoid sinus was ligated and divided, the facial nerve was displaced anterosuperiorly, and the inner ear structures were preserved. Dural opening exposed the anterolateral and anterior surfaces of the medulla, the pontomedullary junction, and the spinomedullary junction. The ipsilateral vertebral artery and often the contralateral vertebral artery and the vertebrobasilar junction, the caudal cranial nerves, and the origin of the 6th, 7th, and 8th cranial nerves were well exposed. To expose the structures of the middle clivus, we drilled away the labyrinth, the cochlea, and a portion of the clival bone. The facial nerve was displaced posteroinferiorly. Dural opening exposed the ipsilateral anterior surface of the pons, the midbasilar artery, and the ipsilateral 5th, 6th, 7th, and 8th cranial nerves. A portion of the contralateral anterior surface of the pons was also exposed at times. The superior limit of this exposure was just above the origin of the trigeminal nerve. The exposure of the upper clival structures was limited with this approach, and required medial temporal lobe retraction. Two case reports are included to illustrate the application of the transtemporal approach to the exposure and clipping of aneurysms of the vertebrobasilar system. The advantages and disadvantages of this approach are discussed.

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Preservation of Facial, Cochlear, and other Nerve Functions in Acoustic Neuroma Treatment

Otolaryngology ◽

10.1177/019459989411000202 ◽

1994 ◽

Vol 110 (2) ◽

pp. 146-155 ◽

Cited By ~ 82

Author(s):

Jean-Marc Sterkers ◽

Gavin A. J. Morrison ◽

Olivier Sterkers ◽

Mohamed M. K. Badr El-Dine

Keyword(s):

Facial Nerve ◽

Cranial Nerves ◽

Surgical Excision ◽

Hearing Preservation ◽

Middle Fossa ◽

Middle Fossa Approach ◽

Translabyrinthine Approach ◽

Number Of Patients ◽

Facial Nerve Monitoring ◽

Facial Function

Between March 1966 and September 1992, 1400 acoustic neuromas were treated in Paris, France, by surgical excision. The findings over the last 7 years are presented. The translabyrinthine approach has been used in more than 85% of cases. Where hearing preservation is attempted, the middle fossa approach has been adopted for intracanilicular tumors and the retrosigmoid approach for small tumors extending into the cerebellopontine angle, in which the fundus of the internal meatus is free of tumor. The main goal is to achieve a grade I or II result in facial function within 1 month of surgery. Results improved during 1991 after the introduction of continuous facial nerve monitoring and the use of the Beaver mini-blade for dissection of tumor from nerve. With these techniques, facial function at grade I or II at 1 month improved from 20% to 52% for large tumors (larger than 3 cm), from 42% to 81% for medium tumors (2 to 3 cm), and from 70% to 92% for small tumors (up to and including 2 cm extracanalicular). The facial nerve was at greater risk using the retrosigmoid or middle fossa approaches than by the translabyrinthine route. Since 1985, success in hearing preservation has changed little, with useful hearing being preserved in 38.2% of cases operated on by means of the retrosigmoid route and 36.4% of cases after the middle fossa approach. In older patients with good hearing and small tumors, observation with periodic MRI scanning is recommended. Despite earlier diagnosis, the number of patients suitable for hearing preservation surgery remains very limited and careful selection is required. Trigeminal nerve signs were present in 20% of cases preoperativey, in 10% postoperatively, and recovered spontaneously. Palsies of the other cranial nerves after surgery were much rarer and were as follows: sixth nerve (abducens), 0.5%; ninth nerve (glossopharyngeal), 1.4%; and tenth nerve (vagus), 0.7%. The importance of preservation of function of the nervus intermedius of Wrisberg is stressed. These results emphasize the advantages of the translabyrinthine approach, offering greater security to the facial nerve and lower morbidity.

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Surgical treatment of glossopharyngeal nerve schwannomas: Results of two-center study (14 patients included) and literature review

Ukrainian Neurosurgical Journal ◽

10.25305/unj.240739 ◽

2021 ◽

Vol 27 (4) ◽

pp. 23-29

Author(s):

Andrii H. Sirko ◽

Oleksandr M. Lisianyi ◽

Оksana Y. Skobska ◽

Rostislav R. Malyi ◽

Iryna O. Popovych ◽

...

Keyword(s):

Surgical Treatment ◽

Facial Nerve ◽

Hearing Impairment ◽

Cranial Nerves ◽

Type A ◽

Jugular Foramen ◽

Type B ◽

Tumor Removal ◽

Type D ◽

Total Tumor Removal

Objective: This study is aimed to analyze the outcomes of surgical treatment of glossopharyngeal schwannomas based on pre- and postoperative neurological status assessment. Materials and methods: This paper is a retrospective analysis of examination and surgical treatment of 14 patients who were operated on in two large clinics from 2018 to 2021 inclusive. When analyzing the collected data, gender, age, disease symptoms, tumor size and location, surgical approach, tumor to cranial nerves (CN) ratio, jugular foramen (JF) condition, and tumor removal volume were taken into account. All tumors were divided into groups depending on tumor location relative to the JF. Particular attention was paid to assessing cranial nerves functions. Facial nerve function was assessed as per House-Brackmann Scale (HBS), hearing function as per Gardner-Robertson Scale (GRS). Results: 3 (21.4%) patients had total tumor removal: 2 patients had type A tumors and one had type B tumor. Subtotal resection took place in 7 (50%) cases. In 4 cases, a tumor was partially removed: 3 patients had type D tumors and one had type B tumor. 3 (21.4%) patients had preoperative FN deficit (HBS Grade II) and mild dysfunction. 5 (35.7%) patients had postoperative facial nerve deficit: HBS ІІ, 2; ІІІ, 1; V, 2. Preoperative sensorineural type hearing impairment on the affected side was diagnosed in 13 (92.6%) patients. Before surgery, 6 patients had non-serviceable hearing, which remained at the same level after surgery. None of the patients with grade I or II hearing before surgery had any hearing impairment postoperatively. In 2 (14.3%) cases, hearing improved from grade V to grade III after surgery. 6 (42.9%) patients developed new neurological deficit in the caudal group CN. Postoperative deficit of the caudal group CN occurred in type D tumors in 3 patients, type A tumors 2 patients, and type B tumors one patient. Conclusions: Applying a retrosigmoid approach only makes it possible to achieve total tumor removal in case of type A tumors. To remove other tumor types, it is necessary to select approaches that enable access to the jugular foramen and infratemporal fossa. Intraoperative neurophysiological monitoring is an extremely important tool in glossopharyngeal schwannoma surgery. The most common postoperative complication is a developed or increased deficit of the caudal CN group, which can lead to persistent impairments in the patients’ quality of life. Preservation of the CN VII and VIII function in most cases is a feasible task and shall be ensured as a standard for this pathology.

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Cephalic tetanus manifesting as isolated facial nerve palsy- a case report from rural Armenia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13817 ◽

2021 ◽

Vol 15 (11) ◽

pp. 1770-1773

Author(s):

Armen Kishmiryan ◽

Jeevan Gautam ◽

Deeksha Acharya ◽

Bishnu Mohan Singh ◽

Armen Ohanyan ◽

...

Keyword(s):

Case Report ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Early Recognition ◽

Cranial Nerves ◽

Tetanus Antitoxin ◽

The Face ◽

Cephalic Tetanus ◽

Initiation Of Therapy

Cephalic tetanus is a rare clinical form of tetanus, clinically characterized by trismus and cranial nerve palsy involving one or more cranial nerves, facial nerve being the most common. We report a case of cephalic tetanus with left-sided lower motor facial nerve palsy in a 66-year-old non-immunized patient after an untreated laceration injury. The patient had dysphagia, spasm of the muscles of mastication, asymmetry of the left side of the face, cough, shortness of breath, and stiffness of neck muscles. The presentation was unique given that the facial nerve palsy appeared prior to the occurrence of trismus, which misled the initial diagnosis towards Bell's palsy. He was successfully treated with tetanus antitoxin without any adverse events. Although widespread use of tetanus vaccine has led to a dramatic decline in this fatal disease, sporadic disease occurrence is still possible, particularly in individuals without up-to-date vaccinations. In this case report we illustrate the importance of early recognition of cephalic tetanus prior to the development of the full clinical picture. The early initiation of therapy is the key to recovery from this deadly disease. Physicians are encouraged to include cephalic tetanus as a cause of facial nerve palsy in their differential. In particular, paying attention to cases manifesting early after head or neck injury.

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INCIDENCE OF CRANIAL NERVE PARALYSIS IN POLIOMYELITIS IN RELATION TO PRESENCE OR ABSENCE OF TONSILS

PEDIATRICS ◽

10.1542/peds.21.1.106 ◽

1958 ◽

Vol 21 (1) ◽

pp. 106-111

Author(s):

F. H. Top

Keyword(s):

Facial Nerve ◽

Rural Area ◽

Cranial Nerve ◽

Cranial Nerves ◽

Nerve Paralysis ◽

Cranial Nerve Paralysis ◽

Clinical Type ◽

Composite Study

A study of patients from a largely rural area in Iowa corroborates the evidence of many previous studies that bulbar and bulbospinal types of poliomyelitis occur more commonly in persons whose tonsils have been removed irrespective of the time in life the operation was performed. The tonsillectomy rate for all cases was the lowest encountered thus far. Agreement is not on the same level as noted in the author's Detroit composite study previously reported, and is more marked for bulbospinal than for the bulbar type of poliomyelitis (some studies combine bulbar and bulbospinal cases). Adjustment for age reduces differences between cases with tonsils absent and tonsils present by clinical type and further strengthens the finding of Paffenbarger and of the author's Detroit composite study that age must be reckoned with in an assessment of the problem. Incidence of paralyses of cranial nerves by tonsillectomy status is similar to the Detroit composite study in the case of palatal and pharyngeal paralyses but less strongly; incidence of paralysis of the facial nerve is dissimilar.

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Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children

Journal of Neurosurgery ◽

10.3171/jns.1997.86.1.0001 ◽

1997 ◽

Vol 86 (1) ◽

pp. 1-4 ◽

Cited By ~ 42

Author(s):

Paul A. Grabb ◽

A. Leland Albright ◽

Robert J. Sclabassi ◽

Ian F. Pollack

Keyword(s):

Facial Nerve ◽

Nerve Injury ◽

Cranial Nerves ◽

Lateral Rectus ◽

Emg Activity ◽

Facial Muscle ◽

Nerve Injuries ◽

Content Type ◽

Seventh Nerve ◽

Fine Print

✓ The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculatures were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year. Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries. Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.

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Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940711600710 ◽

2007 ◽

Vol 116 (7) ◽

pp. 542-549 ◽

Cited By ~ 50

Author(s):

Sertac Yetiser ◽

Ugur Karapinar

Keyword(s):

Facial Nerve ◽

Meta Analysis ◽

Statistical Significance ◽

Cranial Nerves ◽

Facial Nerve Paralysis ◽

Nerve Function ◽

Facial Nerve Function ◽

Reliable Technique ◽

Nerve Paralysis ◽

Nerve Anastomosis

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.

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