Facial and Cochlear Nerve Function after Surgery of Cerebellopontine Angle Meningiomas

Nakamura, Makoto; Röser, Florian; Dormiani, Mehdi; Matthies, Cordula; Vorkapic, Peter; Samii, M.

doi:10.1227/01.neu.0000154699.29796.34

Cited by 103 publications

(79 citation statements)

References 25 publications

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“…1,10,14,16 Multiple factors, including preoperative facial nerve status, surgical approach, anatomical location, and involvement of the IAC, likely contribute to perioperative CN VII dysfunction. 1,10,17,18,23 In the study by Agarwal et al, permanent CN complications were reported in 5.9% patients with tumors smaller than 3 cm and in 45.5% of the cases in which the lesions were larger than 3 cm and were more frequent in those undergoing STR than in those undergoing GTR. 1 Similarly, Leonetti et al reported permanent postoperative complications in 8 (27.6%) patients, with CN VII dysfunction specifically being reported in 3 (10.3%) patients.…”

Section: 25mentioning

confidence: 95%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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ABBREVIATIONS CN = cranial nerve; CPA = cerebellopontine angle; EMG = electromyography; EOR = extent of resection; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; IAC = internal auditory canal; STR = subtotal resection; TTP = time to progression. SUBMITTED August 3, 2016 OBJECTIVE Advanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC). METHODS Medical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve-sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated. RESULTS According to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes. CONCLUSIONS CPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass ef...

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Section: 25mentioning

confidence: 95%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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“…6 Compared with VS, meningiomas are the next most common CPA tumor constituting 10% to 15% of all CPA tumors. 1 The treatment and operative approach differ for VS and meningioma, and consequently an accurate preoperative diagnosis is warranted to distinguish these 2 tumors. 7 Meningiomas seem to offer better chances to preserve hearing than VS. 1,7 An accurate preoperative diagnosis may influence the prognosis because meningiomas are known to have a higher incidence of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…1 The treatment and operative approach differ for VS and meningioma, and consequently an accurate preoperative diagnosis is warranted to distinguish these 2 tumors. 7 Meningiomas seem to offer better chances to preserve hearing than VS. 1,7 An accurate preoperative diagnosis may influence the prognosis because meningiomas are known to have a higher incidence of recurrence. 7 Multiplanar capability, superior soft tissue contrast resolution, and lack of beam hardening artifacts make MR imaging the preferred technique to assess CPA tumors.…”

Section: Discussionmentioning

confidence: 99%

“…VS constitute 80% to 90% and meningiomas 10% to 15% of CPA tumors. 1 It is essential to distinguish these 2 lesions accurately before surgery because the outcome with preservation of hearing is better with meningiomas. 1 MR imaging is considered the imaging method of choice to assess CPA tumors and to distinguish VS from meningiomas.…”

mentioning

confidence: 99%

“…1 It is essential to distinguish these 2 lesions accurately before surgery because the outcome with preservation of hearing is better with meningiomas. 1 MR imaging is considered the imaging method of choice to assess CPA tumors and to distinguish VS from meningiomas. A tumor in the internal auditory canal (IAC) with dilation of the canal is highly suggestive of VS. Signs such as the presence of hyperostosis, calcification, broad base of the tumor against the tentorium, and a dural tail may favor the diagnosis of a meningioma.…”

mentioning

confidence: 99%

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Intratumoral Microhemorrhages on T2*-Weighted Gradient-Echo Imaging Helps Differentiate Vestibular Schwannoma From Meningioma

Thamburaj

Radhakrishnan

Thomas

et al. 2007

AJNR Am J Neuroradiol

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The most commonly injured nerves at surgery: A comprehensive review

et al. 2020

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Iatrogenic nerve injury during surgery is a major source of concern for both patients and surgeons. This study aimed to identify the nerves most commonly injured during surgery, along with the commonly associated operative procedures. A literature search was conducted using the PubMed database to identify nerves commonly injured during surgery, along with the surgical procedure associated with the injury. The following 11 nerves, ranked in order with their associated surgical procedures, were found to be the most commonly injured: (a) intercostobrachial nerve in axillary lymph node dissections and transaxillary breast augmentations, (b) vestibulocochlear nerve in cerebellopontine tumor resections and vestibular schwannoma removals, c) facial nerve in surgeries of the inner ear and cheek region, (d) long thoracic nerve in axillary lymph node dissections, (e) spinal accessory nerve in surgeries of the posterior triangle of the neck and cervical lymph node biopsies, (f) recurrent laryngeal nerve in thyroid surgeries, (g) genitofemoral nerve in inguinal hernia and varicocele surgeries, (h) sciatic nerve in acetabular fracture repairs and osteotomies, (i) median nerve in carpal tunnel release surgeries, (j) common fibular nerve in varicose vein and short saphenous vein surgeries, and (k) ulnar nerve in supracondylar fracture surgeries. Although the root cause of iatrogenic nerve injury differs for each nerve, there are four unifying factors that could potentially decrease this risk for all peripheral nerves. These four influencing factors include knowledge of potential anatomical variations, visual identification of at‐risk nerves during the procedure, intraoperative nerve monitoring, and expertise of the surgeon.

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Facial and Cochlear Nerve Function after Surgery of Cerebellopontine Angle Meningiomas

Cited by 103 publications

References 25 publications

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Intratumoral Microhemorrhages on T2*-Weighted Gradient-Echo Imaging Helps Differentiate Vestibular Schwannoma From Meningioma

The most commonly injured nerves at surgery: A comprehensive review

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