Long-term facial nerve function following facial reanimation after translabyrinthine vestibular schwannoma surgery: A comparison between sural grafting and VII–XII anastomosis

Abstract

The aim of this study was to compare the recovery of long-term facial nerve function between patients who received sural grafts and those who underwent hypoglossal-facial anastomosis techniques following translabyrinthine vestibular schwannoma surgery. This study included 25 patients with vestibular schwannomas treated with translabyrinthine tumor removal. All patients had large tumors with a mean tumor size of 3.12 cm. Of these patients, six had progressive tumor enlargement symptoms and had been treated previously with stereotactic irradiation. Preoperatively, all patients had normal facial functions, and total tumor removal with a translabyrinthine approach was achieved in all cases. During surgery, the facial nerve was interrupted in all 25 patients. Two types of facial reanimation were performed. Sural grafts were placed in 13 patients and hypoglossal-facial (VII–XII) anastomosis was performed in the other 12. Facial nerve function and surgical outcomes were observed upon discharge, in the short term (one year following surgery), and in the long term (three years following surgery). Total facial paresis was observed in all patients upon discharge. In the sural graft group, House-Brackmann grade III facial function was achieved in four patients upon short-term evaluation and in ten upon long-term evaluation, while House-Brackmann grade IV facial function was achieved in nine patients upon short-term evaluation and three in the long term. In the VII-XII anastomosis group, House-Brackmann grade III facial function was achieved in two patients in the short term and eight in the long term, and House-Brackmann grade IV facial function was achieved in ten patients in the short term and four in the long term. There was a statistically significant difference in the facial recovery results between the short- and long-term follow-up periods. The sural graft group exhibited a marked improvement in results compared with the VII–XII anastomosis group, but no statistically significant difference in facial function was observed between the two facial reanimation groups at either the short- or long-term follow-up. In the sural graft group, synkinesia, noted in three patients, was the most frequently observed complication. Claudication was common upon discharge (four patients), but diminished during follow-up. Disarticulation was the most common complication in the VII–XII anastomosis group (five patients); numbness of the tongue was the second most common complication (four patients). None of the patients developed dysphagia. Facial reanimation is an effective procedure for the surgical rehabilitation of static and dynamic facial nerve functions. Significant improvement in facial nerve function may occur more than three years after surgery. Despite morbidities such as synkinesia, the sural graft technique demonstrates greater improvements in facial nerve function than VII–XII anastomosis in the short and long term following surgery, but this conclusion requires confirmation by larger studies with a greater number of patients.

Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

“…9 Recent studies have shown that cable nerve graft interpositioning provides as good a result as a primary end-to-end coaptation. 2,17,47,50 However, the best possible postoperative outcome is HB Grade III, regardless of the graft material used or the technique employed, because the frontal muscle function rarely recovers and a certain degree of synkinesis is unavoidable after grafting. 2,30,39 The factors that could influence the results of FN reconstruction are discussed below.…”

“…Delicate maneuvers of nerve approximation like peri-neurial, group funicular, and epineurial suturing are very difficult to perform in the depths of a pulsating CPA and even more so by a tired surgeon subsequent to a long and frequently laborious procedure. 50 Furthermore, the FN lacks a true fascicular organization until the geniculate ganglion, 2,8,9,29 and this makes it practically impossible to perform any kind of epi-or perineurial suturing until the geniculate ganglion. Hence, we prefer to use stitch-less fibrin glue for coaptation in the intradural and transdural anastomoses.…”

Hypoglossal–facial nerve ‘side’-to-side neurorrhaphy using a predegenerated nerve autograft for facial palsy after removal of acoustic tumours at the cerebellopontine angle

“…The three patients who experienced less satisfactory outcomes had suffered from facial palsy for more than 1 year, consistent with a need for rapid surgical intervention. For the current methods of facial reanimation using the HN–FN end-to-end or ‘side’-to-end neurorrhaphy with or without a fresh nerve graft, the best possible outcome in a small proportion of patients is H-B grade III, and improvements are detected only after 6–12 months 4 20–24. Thus, our new surgical method, based on fundamental concepts and our own recent experimental results, represents a major advance in the rehabilitation of FN injury.…”

“…Since classic HN–FN end-to-end neurorrhaphy causes serious neurological deficits resulting from the sacrifice of the HN, surgical interventions have been improved by transferring half of the HN to the injured FN, either directly or via a nerve graft 4. However, clinical outcomes remain unsatisfactory and the postoperative recovery period is very long, sometimes beyond 2 years.…”

28 Cranial Nerve Reconstruction

“…• Despite morbidities such as synkinesia, sural graft techniques may show better improvement in facial nerve function than a CN XII to CN VII anastomosis at 1-and 3-year follow-up after surgery. 4 • In a successful facial nerve anastomosis, the typical recovery has the following trajectory 5 :…”