Auditory and Facial Nerve Function Following Surgery for Cerebellopontine Angle Meningiomas

Batra, Pete S.; Dutra, José; Wiet, Richard J.

doi:10.1001/archotol.128.4.369

Cited by 33 publications

(36 citation statements)

References 11 publications

(20 reference statements)

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“…6 The posterior surface of the petrous bone is a region surrounded by the superior petrosal sinus, inferior petrosal sinus and sigmoid sinus. In the past, meningiomas that extended into the CPA region, regardless of the location of the base, were considered to be CPA meningiomas.…”

Section: Discussionmentioning

confidence: 99%

The Classification of Posterior Petrous Meningiomas and Its Clinical Significance

Zhou

Wang

et al. 2009

J Int Med Res

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This retrospective analysis of the clinical records of 42 patients was used to study the clinical significance of a classification system for posterior petrous meningiomas. According to clinical manifestations and radiological images, posterior petrous meningiomas were classified into three types: type I (cerebella type; 12 patients), tumours involved and compressed the cerebellum; type II (cranial nerve type; 16 patients), tumours involved the cranial nerves; and type III (combined type; 14 patients), tumours involved more than one structure such as the cerebellum, cranial nerves and the brain stem. All patients underwent microneurosurgery and the total resection rate was 90%. It was more difficult totally to resect type II and III tumours than type I tumours and the post-operative functional outcomes were worse. Microneurosurgical techniques and skills are critical to increase the total resection rate of posterior petrous meningiomas in order to decrease the mortality and disability rates.

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Section: Discussionmentioning

confidence: 99%

The Classification of Posterior Petrous Meningiomas and Its Clinical Significance

Zhou

Wang

et al. 2009

J Int Med Res

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“…1). Other reported locations include optic nerve sheath [21], cavernous sinus [22], falcine, tentorial, and petroclival [23], cerebellopontine angle [24], intraventricular, foramen magnum [23], peritorcular, infratemporal fossa [25], and jugular fossa [6].…”

Section: Locationmentioning

confidence: 99%

Treatment of meningioma: An update

D’Ambrosio

Bruce

2003

Curr Neurol Neurosci Rep

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Aggressive surgical resection continues to be the mainstay of current meningioma management, with advances in microsurgical techniques facilitating the safety and effectiveness of this approach. Complete surgical removal of meningiomas provides the optimal opportunity for long-term remission. Advances in skull base surgical approaches have greatly improved patient outcomes for tumors in precarious locations once thought to be inoperable. For tumors that recur or are unresectable, stereotactic radiosurgery and conformal fractionated radiation therapy can provide safe, palliative treatment with favorable long-term outcomes. Additionally, advances in the understanding of molecular biologic and biochemical mechanisms underlying meningioma growth offer unique opportunities for potential treatment adjuncts for atypical and malignant tumors. This review discusses current understanding of meningioma pathology and accepted meningioma treatment paradigms. The technologic advances and experimental strategies for the future treatment of complex intracranial meningiomas are also discussed.

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“…On the other hand, even the light nerve crush (50 mm/s) injured the facial nerve and resulted in paralyzed vibrissal muscles macroscopical intra-operative preservation of the facial nerve is about 98 % (Kartush and Bouchard 1992). This is why, it is very astonishing that postoperative peripheral facial nerve palsy (immediate or delayed) occurs in 20-40 % of the patients with cerebellopontine angle (CPA) tumors (Arriaga et al 1993;Batra et al 2002;Glockner and Hopf 2006).…”

Section: Introductionmentioning

confidence: 99%

Nerve crush but not displacement-induced stretch of the intra-arachnoidal facial nerve promotes facial palsy after cerebellopontine angle surgery

et al. 2016

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Little is known about the reasons for occurrence of facial nerve palsy after removal of cerebellopontine angle tumors. Since the intra-arachnoidal portion of the facial nerve is considered to be so vulnerable that even the slightest tension or pinch may result in ruptured axons, we tested whether a graded stretch or controlled crush would affect the postoperative motor performance of the facial (vibrissal) muscle in rats. Thirty Wistar rats, divided into five groups (one with intact controls and four with facial nerve lesions), were used. Under inhalation anesthesia, the occipital squama was opened, the cerebellum gently retracted to the left, and the intra-arachnoidal segment of the right facial nerve exposed. A mechanical displacement of the brainstem with 1 or 3 mm toward the midline or an electromagnet-controlled crush of the facial nerve with a tweezers at a closure velocity of 50 and 100 mm/s was applied. On the next day, whisking motor performance was determined by video-based motion analysis. Even the larger (with 3 mm) mechanical displacement of the brainstem had no harmful effect: The amplitude of the vibrissal whisks was in the normal range of 50°-60°. On the other hand, even the light nerve crush (50 mm/s) injured the facial nerve and resulted in paralyzed vibrissal muscles (amplitude of 10°-15°). We conclude that, contrary to the generally acknowledged assumptions, it is the nerve crush but not the displacement-induced stretching of the intra-arachnoidal facial trunk that promotes facial palsy after cerebellopontine angle surgery in rats.

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Auditory and Facial Nerve Function Following Surgery for Cerebellopontine Angle Meningiomas

Abstract: This review demonstrates that successful hearing preservation is possible with meningiomas. Therefore, the retrosigmoid approach should be used whenever serviceable hearing is present preoperatively. Normal facial nerve function can also be preserved in the majority of patients.

Cited by 33 publications

References 11 publications

The Classification of Posterior Petrous Meningiomas and Its Clinical Significance

The Classification of Posterior Petrous Meningiomas and Its Clinical Significance

Treatment of meningioma: An update

Nerve crush but not displacement-induced stretch of the intra-arachnoidal facial nerve promotes facial palsy after cerebellopontine angle surgery

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