Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma

Park, Seong‐Hyun; Lee, Kyu-Yup; Hwang, Sung-Kyoo

doi:10.3171/2012.10.jns12747

Cited by 12 publications

(19 citation statements)

References 16 publications

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“…1,8,15,22 The disturbances to functions of the nonmotor portions of the facial nerve after VS surgery or radiosurgery have been sporadically reported in the literature. 13,14,16,20,21,24 In this study, we present a prospective analysis of the clinical aspects of the dysfunctions of the nonmotor portion of the facial nerve after VS surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Metwali¹,

Kniese²,

Kardavani³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE The 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. METHODS In 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. RESULTS The 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. CONCLUSIONS The 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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Section: Discussionmentioning

confidence: 99%

“…of VS. 14,20,24 Some studies depended on self-assessment questionnaires mailed to the patients. 14,20 The taste sensation in cases of VS could be objectively tested using taste strips 4,9 or solutions. 16 It could also be tested using electrogustometry.…”

mentioning

confidence: 99%

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

Metwali¹,

Kniese²,

Kardavani³

et al. 2019

Journal of Neurosurgery

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“…One study found that 18% of vestibular schwannoma patients had nervus intermedius dysfunctions of lacrimation, salivation, nasal secretion, or taste prior to radiosurgery, increasing to 18 (36%) of 50 after radiosurgery. 4 This suggests that both the primary tumor itself and the treatment of the tumor can lead to disruption of nervus intermedius pathways. Once the normal neurologic pathways have been damaged, cross-innervation can occur, even before surgery, as evidenced by our first patient.…”

Section: Discussionmentioning

confidence: 99%

Autonomic Cross-Innervation in Patients With Neurofibromatosis Type 2: Frey Syndrome and Unilateral Epiphora With Rhinorrhea

Evans

Nascene

Sommer

et al. 2019

Child Neurology Open

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The authors present 2 cases of cross-innervation in patients with neurofibromatosis type 2. In the first case, an iodine test was performed to demonstrate Frey syndrome in a 28-year-old female with neurofibromatosis type 2 who developed symptoms at age 10 years. The second patient is an 18-year-old female with neurofibromatosis type 2, 2 years status post left vestibular schwannoma subtotal resection who presented with paradoxical unilateral lacrimation and rhinorrhea triggered by heat stress and exercise. The pathophysiology of these cases is discussed.

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“…In this patient, the tumor has not grown significantly over several months with intact, meaningful hearing in place. This tumor based on the location is not removable without sacrificing hearing; therefore, repeat MRI every 6-12 months is warranted to observe for any changes that may warrant surgical removal, while ongoing hearing evaluations are conducted to allow the patient to enjoy intact function for as long as possible nervus intermedius, manifested as disturbances in taste, salivation, or lacrimation (22-45 %), has been documented despite normal facial nerve motor function [59].…”

Section: Complicationsmentioning

confidence: 99%

“…Non-obstructive hydrocephalus may be secondary to radiation-induced tumor necrosis and release of tumor proteins into CSF that impairs resorption by arachnoid granulations [54]. Hydrocephalus requiring a ventricular shunt occurs in up to 7 % of cases [40,52,53,59] and at higher rates with larger VS [42,43,60,61].…”

Section: Complicationsmentioning

confidence: 99%

Vestibular Schwannomas: Surgical and Nonsurgical Management

2015

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Management options of vestibular schwannomas continue to evolve as surgical, radiation, and radiologic imaging techniques and technology change and improve over time. Currently, three options for these tumors exist and include primary surgical extirpation, stereotactic radiation, and observation with serial imaging. Skull base surgeons are charged with providing the patient with a comprehensive discussion of each option based on the inherit risks and benefits of each option to craft a management plan based on numerous factors that include age, tumor location, and size, hearing level at presentation and any medical comorbidities that may influence functional outcomes and quality of life. The purpose of this article was to review the surgical and non-surgical approaches to tumor management highlighting the risks and benefits and ongoing controversies between modalities regarding optimal functional outcomes. A particular emphasis is placed on hearing preservation and facial nerve function after treatment.

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Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma

Cited by 12 publications

References 16 publications

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

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

Autonomic Cross-Innervation in Patients With Neurofibromatosis Type 2: Frey Syndrome and Unilateral Epiphora With Rhinorrhea

Vestibular Schwannomas: Surgical and Nonsurgical Management

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