Impact of Facial Dysfunction on Quality of Life after Vestibular Schwannoma Surgery

Lassaletta, Luis; Alfonso, Carolina; Rı́o, Laura Del; Roda, J.M.; Gavilán, Javiér

doi:10.1177/000348940611500908

Cited by 54 publications

(42 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,5,15 Facial nerve (CN VII) palsy is a particularly adverse outcome of surgery within the CPA, occurring in 6% to 29% of patients and causing disfiguring and disabling facial paralysis that detracts from a patient's quality of life. 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.…”

Section: 25mentioning

confidence: 99%

“…Damage to the facial nerve (cranial nerve [CN] VII) is a particularly adverse outcome of resection, and disfiguring and disabling facial paralysis has been demonstrated to significantly detract from patient quality of life. 14,16 In general, the morbidity associated with CPA meningiomas is attributed to the way the tumors surround or infiltrate nearby cranial nerves and/or the brainstem. 5 In light of this, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

View full text Add to dashboard Cite

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...

show abstract

Section: 25mentioning

confidence: 99%

mentioning

confidence: 99%

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

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…11,27 Previous studies have demonstrated that among patients with sporadic VS, ongoing dizziness and headache are associated with the greatest health-related quality of life (HRQOL) reduction, whereas the contributions of unilateral hearing loss, tinnitus, and facial neuropathy are generally less by comparison. [2][3][4]22,26 Despite the substantial physical and emotional burden associated with headache in patients with VS, this condition remains understudied. To our knowledge, no publications have specifically characterized headache in patients with VS receiving SRS or conservative observation.…”

mentioning

confidence: 99%

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Carlson¹,

Tveiten

Driscoll³

et al. 2015

JNS

View full text Add to dashboard Cite

O ver the last 100 years, the treatment of vestibular schwannoma (VS) has undergone tremendous evolution. 32 With the increasing use of less invasive management methods including observation, stereotactic radiosurgery (SRS), or radiotherapy and subtotal or neartotal resection, incidences of disease-associated mortality, stroke, and permanent facial neuropathy have been substantially reduced. 12,27,32,41 obJect The primary goals of this study were: 1) to examine the influence of disease and treatment on headache in patients with sporadic vestibular schwannoma (VS); and 2) to identify clinical predictors of long-term headache disability.methods This was a cross-sectional observational study with international multicenter enrollment. Patients included those with primary sporadic < 3-cm VS and a separate group of general population control subjects without tumors. Interventions included a postal survey incorporating the Headache Disability Inventory (HDI), the Hospital Anxiety and Depression Scale, and a VS symptom questionnaire. The main outcome measures were univariate and multivariable associations with HDI total score. results The overall survey response rate was 79%. Data from 538 patients with VS were analyzed. The mean age at time of survey was 64 years, 56% of patients were female, and the average duration between treatment and survey was 7.7 years. Twenty-seven percent of patients received microsurgery, 46% stereotactic radiosurgery, and 28% observation. Patients with VS who were managed with observation were more than twice as likely to have severe headache disability compared with 103 control subjects without VS. When accounting for baseline differences, there was no statistically significant difference in HDI outcome between treatment modalities at time of survey. Similarly, among the microsurgery cohort, the long-term risk of severe headache disability was not different between surgical approaches. Multivariable regression demonstrated that younger age, greater anxiety and depression, and a preexisting diagnosis of headache were the primary predictors of severe long-term headache disability, while tumor size and treatment modality had little influence. coNclusioNs At a mean of almost 8 years following treatment, approximately half of patients with VS experience headaches of varying frequency and severity. Patient-driven factors including age, sex, mental health, and preexisting headache syndrome are the strongest predictors of long-term severe headache disability. Tumor size and treatment modality have less impact. These data may assist with patient counseling regarding long-term expectations following diagnosis and treatment.

show abstract

“…En manos de cirujanos experimentados, con el uso de técnicas microquirúrgicas y de monitorización electromiográfica intraoperatoria, se consiguen muy buenos resultados (grados I-II H/B) en el 60-90% de los pacientes [37][38][119][120] . Se ha publicado una tasa de preservación anatómica del VII tan alta como del 95% 103 .…”

Section: Función Facialunclassified

“…Sin embargo, a pesar de que en nuestro estudio no demostramos una relación significativa entre el grado de disfunción facial y la CV, un número significativo de pacientes se quejaron de síntomas relacionados con la función facial y problemas oculares en el cuestionario abierto, lo cual ha sido evidenciado también por otros autores 69,86,92,96,119,123 . En nuestro estudio el 30% de los pacientes se quejaron de algún grado de disfunción facial, cifra sólo por detrás en frecuencia de la disfunción auditiva y de los problemas de estabilidad o equilibrio.…”

Section: Función Facialunclassified

Calidad de vida tras la cirugía del schwannoma vestibular

Alfonso

Lassaletta

Sarriá

et al. 2007

Acta Otorrinolaringológica Española

Self Cite

View full text Add to dashboard Cite

Impact of Facial Dysfunction on Quality of Life after Vestibular Schwannoma Surgery

Abstract: An overestimation of the effect of facial paralysis after vestibular schwannoma resection may exist on the surgeon's part. Detailed information about the possibility of hearing loss, vestibular problems, and pain must be given to all patients.

Cited by 54 publications

References 16 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

Risk factors and analysis of long-term headache in sporadic vestibular schwannoma: a multicenter cross-sectional study

Calidad de vida tras la cirugía del schwannoma vestibular

Contact Info

Product

Resources

About