Intracranial repair of interrupted facial nerve in course of operation for acoustic neurinoma by microsurgical technique

Abstract

The microsurgical refinement of the lateral suboccipital approach is, in our opinion, the most satisfactory operative technique for achieving total removal of acoustic neurinomas of all sizes. In this series of 164 operated cases, large or very large tumours accounted for 64% of the cases (105 patients). The facial nerve was sacrificed in about 19% of the cases. In 81% of the cases the facial nerve was respected (65%) or repaired (16%) by direct intracranial suture performed immediately after tumour removal. Good or fair functional results were obtained in about 65% of the cases by this last procedure, which has to be considered as the treatment of choice for facial nerve repair. The results are compared with those of other series and with those obtained by different nerve substitution procedures.

Intracranial nerve repair: a review of experimental and clinical studies

“…The mean time between surgery and start of the recovery is usually 6 months, [40,42] with a range of 4 [3,42] to several years. [66] Although some authors state that after 2 years, further recovery of the facial nerve function cannot be expected, [3,42] it is generally accepted that maximum recovery after facial nerve repair can proceed for up to 10 years after surgery.…”

“…Consequently, every cranial nerve transection should be considered for repair, with the exception of the vestibulocochlear nerve. This nerve has a very long central portion [66] and must be considered as being a part of the central nervous system and thus to have poor regenerative potential.…”

“…For the facial nerve, the published series are obviously much larger. [1,3,8,9,[19][20][21][22]24,29,[39][40][41][42]49,52,66,69,86,90] In some cases of cranial nerve repair, the follow-up period was relatively short. It must be stated that the continued recovery after nerve repair can proceed for 5 to 10 years after surgery, although the most significant improvement is observed within the first 2 years after surgery.…”