Position and Course of Facial Nerve and Postoperative Facial Nerve Results in Vestibular Schwannoma Microsurgery

Mastronardi, Luciano; Cacciotti, Guglielmo; Roperto, Raffaelino; Scipio, Ettore Di; Tonelli, Maria Pia; Carpineta, Ettore

doi:10.1016/j.wneu.2016.06.107

Cited by 46 publications

(12 citation statements)

References 20 publications

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“…Существуют работы [21][22][23], анализирующие исходы функции лицевого нерва в зависимости от топографии невриномы. Так, В.Н.…”

Section: Discussionunclassified

“…У пациентов с передневерхней и передненижней локализацией лицевого нерва функциональные исходы были лучше. Также авторы указывают, что при опухолях размерами более 3 см интраоперационно наблюдалось значительное распла- стывание нерва по капсуле опухоли, его растяжение, и соответственно в этих случаях нарушение функции лицевого нерва в послеоперационном периоде наблюдалось чаще [22], что также было подтверждено результатами проведенного исследования.…”

Section: Discussionunclassified

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The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma

et al. 2018

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Отсроченная нейропатия лицевого нерва представляет собой осложнение, возникающее через 3 сут и более после оперативного вмешательства. Этиология и патогенез данного состояния до конца не изучены, стандарты лечения отсутствуют. По аналогии с параличом Белла в настоящее время для лечения отсроченной нейропатии лицевого нерва используют глюкокортикостероиды (ГКС). Однако для пациентов с противопоказаниями к их применению необходим поиск новых методов терапии. Цель исследования-оценка эффективности и безопасности ботулинотерапии у пациентов с отсроченной нейропатией лицевого нерва после нейрохирургических вмешательств. Материал и методы. Обследованы 33 пациента с отсроченной нейропатией лицевого нерва, возникшей через 3 сут и более после удаления невриномы слухового нерва. В основную группу вошли 18 пациентов с противопоказаниями к использованию ГКС, которым были проведены инъекции ботулинотоксина А (БТА) в мимические мышцы здоровой стороны лица с целью их расслабления. Группу сравнения составили 15 человек, которым был назначен курс преднизолона 1 мг/кг/сут длительностью 5-7 дней. Эффективность лечения оценивали по шкале House-Brackmann и Шкале общего клинического впечатления (Clinical Global Impression Scale). Срок наблюдения после проведенной терапии составил 3 мес. Результаты. Чаще всего отсроченная нейропатия лицевого нерва развивалась при расположении нерва у передненижнего полюса опухоли; при спаянности опухоли с лицевым нервом; при росте опухоли в оральном направлении; при опухоли с нечеткими границами и с размером от 11 до 30 мм. У большинства пациентов обеих групп время возникновения пареза мимических мышц составило более 11 сут после операции. На фоне проводимого лечения как в основной, так и в контрольной группе выявлена значимая положительная динамика: полный регресс асимметрии лица по шкале House-Brackmann составил 83,3 и 93,3% у пациентов основной группы и группы сравнения соответственно через 3 мес после начала лечения. Заключение. Ботулинотерапия может быть рекомендована пациентам с отсроченной нейропатией лицевого нерва, возникшей после удаления невриномы слухового нерва, при противопоказаниях к ГКС. Ключевые слова: невринома слухового нерва, отсроченная нейропатия лицевого нерва, ботулинический токсин типа А.

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Section: Discussionunclassified

The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma

et al. 2018

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“…Location of FN and its adherence to the tumor were evaluated by reviewing radiological images, surgical and video records. The course of the FN was classi ed according to its position in relation to the tumor: anterior (A), anterior-inferior (AI), anterior-superior (AS), and dorsal (D) (28,43). Based on operative reports and videos, tumors were classi ed as cystic (one or more cysts within the tumor), adherent and hypervascular.…”

Section: Methodsmentioning

confidence: 99%

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

Mastronardi

Campione

Boccacci

et al. 2021

Preprint

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Purpose Koos Grade IV vestibular schwannomas (VS) (maximum diameter >3cm) compress the brainstem and displace the fourth ventricle. Microsurgical resection with attention to the right balance between preservation of function and maximal tumour removal is the treatment of choice.Methods Our series consists of 60 consecutive patients with unilateral VS, operated on from December 2010 to July 2019. All patients underwent microsurgical removal via the retrosigmoid approach. The adherence of VS’ capsule to surrounding nervous structures and the excessive tendency of tumor to bleed during debulking, because of a redundant vascular architecture, was evaluated by reviewing video records. Microsurgical removal of tumor was classified as total (T), near-total (NT: residue<5%), subtotal (ST: residue 5-10%) or partial (P: residue>10%).Results Maximal mean tumor diameter was 3,97cm (SD±1,13; range 3,1-5,8cm). Preoperative severely impaired hearing or deafness (AAO-HNS Classes C-D) was present in 52 cases (86,7%). Total or NT resection was accomplished in 46 cases (76,7%), 65,8% in cases with and 95,4% without tight adhesion of capsule to nervous structures (p<0,001). Endoscopic-assisted microsurgical removal of VS in the IAC was performed in 23 patients: in these cases a T resection was obtained in 78,3% versus 45,9% of microsurgery only (p<0,001).The capsule of VS was tightly adherent to nervous structures in 63,3% of patients, whereas hypervascular high-bleeding tumors represented 56,7%. Hearing preservation was possible in 2 out of 8 patients with preoperative class B hearing. At last follow-up, 34 patients (56,7%) had a normal postoperative FN outcome (HBI), 9 (15,0%) were HBII, 8 (13,3%) HBIII, and 9 (15,0%) HBIV. Total-NT resection of solid and low-bleeding VS, without tight capsule adhesion was associated with better FN outcome. Mortality was zero; permanent complications were observed in 2 cases (diplopia, hydrocephalus), transient in 9.Conclusions Microsurgery of Koos Grade IV VS seems to be associated with more than acceptable functional results, with high rate of T and NT removal of tumor. Long-term FN results seem to be worse in patients with cystic Koos Grade IV VS, in cases with tight capsule adherences to nervous structures and in high-bleeding tumors.

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“…All operations were performed by one surgeon through retro sigmoid (RS) approach [29]. The capsule incision and tumor debulking has been performed with hand-held 2µ-Thulium flexible laser fiber (Revolixjr®, Lisa laser USA, Pleasanton, CA, USA).…”

Section: Flexible 2µ-thulium Laser Systemmentioning

confidence: 99%

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

Mastronardi

Cacciotti

Roperto

et al. 2016

Caspian.J.Neurol.Sci

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Background: Vestibular Schwannoma (VS) is one of the skull base tumors originating from vestibular portion of eighth cranial nerve. Recently, 2 microThulium laser is used in the surgery of some intracranial tumors. Objectives: Assessing the efficacy of 2 micro-Thulium flexible hand-held laser fiber (Revolixjr ® ) in microsurgical removal of VS. Materials and Methods:This retrospective non-randomized study was carried out from July 2012 to November 2015. 39 patients with VS had been operated on with microsurgical technique via retro-sigmoid approach. 2 micro-Thuliumfiber hand-held flexible laser was used for tumor resection in 39 cases. Facial nerves function by House-Brackmann (HB) scale and hearing state were assessed preoperatively and 1 week and 6-month postoperatively. Results: Overall time of surgery changed only in proportion with the size of tumor (185-575 minutes) and was not affected by the use of laser. In 5out of 39cases, preoperative facial nerve palsy HB2, and in one case HB4 (permanent) was observed. On considering 38 cases, at 6-month follow-up facial nerve preservation rate (HB1) was 92.1% (from May 2015 all patients had not postoperative facial palsy). Hearing preservation rate was possible in 12 out of 15 cases with previously acceptable preoperative hearing state (AAO-HNS A and B classes). The mean surgeon satisfaction rate of usefulness of this technic was 2.7 in a 0-3-scale Conclusions: A good functional outcome including facial nerve preservation and hearing preservation was obtained by micro-Thulium-fiber hand-held flexible laser microsurgery.

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Position and Course of Facial Nerve and Postoperative Facial Nerve Results in Vestibular Schwannoma Microsurgery

Cited by 46 publications

References 20 publications

The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma

The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

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Position and Course of Facial Nerve and Postoperative Facial Nerve Results in Vestibular Schwannoma Microsurgery

Cited by 46 publications

References 20 publications

The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma

The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between&nbsp;Preservation of Function and Maximal Tumor Removal

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

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Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal