Preservation of Function in Vestibular Schwannoma Surgery

Gharabaghi, Alireza; Samii, Amir; Koerbel, Andrei; Rosahl, Steffen K.; Tatagiba, Marcos; Samii, M.

doi:10.1227/01.neu.0000249245.10182.0d

Cited by 51 publications

(40 citation statements)

References 15 publications

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“…Future clinical applications are currently under investigation in clinical trials. They will include monitoring neuronal signals during tumour resections in the central nervous system (Gharabaghi et al 2007) or as part of brain-computer-interfaces in order to control prosthetic limbs in paralysed human patients (Schalk et al 2007;Pistohl et al 2007). For the latter, there are several new requirements for such electrode arrays: On the one hand, there is a demand of a higher integration density of electrode contacts.…”

Section: Introductionmentioning

confidence: 99%

First long term in vivo study on subdurally implanted Micro-ECoG electrodes, manufactured with a novel laser technology

Henle

Raab

Cordeiro

et al. 2010

Biomed Microdevices

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A novel computer aided manufacturing (CAM) method for electrocorticography (ECoG) microelectrodes was developed to be able to manufacture small, high density microelectrode arrays based on laser-structuring medical grade silicone rubber and high purity platinum. With this manufacturing process, we plan to target clinical applications, such as presurgical epilepsy monitoring, functional imaging during cerebral tumor resections and brain-computer interface control in paralysed patients, in the near future. This paper describes the manufacturing, implantation and long-term behaviour of such an electrode array. In detail, we implanted 8-channel electrode arrays subdurally over rat cerebral cortex over a period of up to 25 weeks. Our primary objective was to ascertain the electrode's stability over time, and to analyse the host response in vivo. For this purpose, impedance measurements were carried out at regular intervals over the first 18 weeks of the implantation period. The impedances changed between day 4 and day 7 after implantation, and then remained stable until the end of the implantation period, in accordance with typical behaviour of chronically implanted microelectrodes. A post-mortem histological examination was made to assess the tissue reaction due to the implantation. A mild, chronically granulated inflammation was found in the area of the implant, which was essentially restricted to the leptomeninges. Overall, these findings suggest that the concept of the presented ECoG-electrodes is promising for use in long-term implantations.

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Section: Introductionmentioning

confidence: 99%

First long term in vivo study on subdurally implanted Micro-ECoG electrodes, manufactured with a novel laser technology

Henle

Raab

Cordeiro

et al. 2010

Biomed Microdevices

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show abstract

“…The dramatic evolution of results in the VS surgery in the past decades has been credited to early diagnosis, improvement in neuro-anesthesiology, intraoperative cranial nerve monitoring and development of microsurgical techniques 12,13,14 . However, surgeons still pursue the ideal management of VS due to the importance of facial nerve function in the patients' quality of life 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The classical surgical technique of tumor debulking and individualization of the neural structures in its most lateral and medial portions was based on the anatomical descriptions of the nerves in the internal auditory canal and on the brainstem surface. Many anatomical reports described important intraoperative references in order to facilitate the identification of the cranial nerves proximal and distal to the tumor, allowing its removal under direct vision of neural structures 12,13,14 . Despite good anatomical knowledge, finding the proximal facial nerve may be difficult, particularly in large tumors.…”

Section: Discussionmentioning

confidence: 99%

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

Vellutini

Beer‐Furlan

Brock

et al. 2014

Arq. Neuro-Psiquiatr.

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The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method: The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results: Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion: The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.Keywords: arachnoid membrane, facial nerve, surgery, vestibular schwannoma, acoustic neurinoma. RESUMOA técnica cirúrgica clássica para ressecção de schwannomas vestibulares enfatiza a anatomia microcirúrgica dos nervos cranianos. Acreditamos que o foco na preservação da membrana aracnóide pode servir como parâmetro seguro para a remoção do tumor. Método: A abordagem extracisternal é descrita em detalhe. Analisamos o prontuário de 120 pacientes tratados com esta técnica entre 2006 e 2012. Os resultados cirúrgicos foram baseados em extensão de ressecção, recorrência tumoral e função do nervo facial. Resultados: Ressecção total foi obtida em 81% dos pacientes. O resultado global da função do nervo facial (House-Brackmann graus I-II) após um ano da cirurgia foi de 93%. Não houve recidiva em um seguimento médio de 4,2 anos. Conclusão: A técnica extracisternal difere de outras descrições cirúrgicas no tratamento de schwannoma vestibular pois não requer a identificação do nervo facial, contanto que o plano de aracnóide seja preservado em toda circunferência do tumor.Palavras-chave: membrana aracnóide, nervo facial, cirurgia, schwannoma vestibular, neurinoma do acústico.Facial nerve injury is a common complication in the treatment of vestibular schwannomas (VS) and its associated facial muscle palsy has a great impact in patients' quality of life 1 . This is the reason why functional preservation of the facial nerve is sought when managing VS with either radiosurgery or microsurgery. Several factors have been correlated with worse facial nerve function outcomes, including older patients, large tumors, and preoperative facial nerve function 2,3,4 . Although careful facial nerve dissection is pursued, anatomical preservation of the facial nerve is not synonymous of normal function 5,6,7 . Intraoperative monitoring of the facial nerve is the key for optimal facial nerve preservation, even though not all patients' clinical courses correlate with their intraoperative electrophysiological result 6,8 . The classical descriptions of the surgical tech...

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“…There is a female predilection, with a 1.5:1 female-to-male ratio 2 . The average age is 34 years, with a peak prevalence in the second and third decades of life 4 Clinically, schwannoma is a slow-growing tumor that may be present for years before becoming symptomatic 5 . Swelling is the most common symptom, but pain or paresthesia may also be present in approximately 50% of such cases 6 .…”

Section: Discussionmentioning

confidence: 99%

Intraosseous Schwannoma of the Left Infra Temporal Region Involving Oral Cavity: A Case Report

Subramaniam¹,

Subramaniam²,

Sable³

et al. 2014

IOSRJDMS

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Preservation of Function in Vestibular Schwannoma Surgery

Cited by 51 publications

References 15 publications

First long term in vivo study on subdurally implanted Micro-ECoG electrodes, manufactured with a novel laser technology

First long term in vivo study on subdurally implanted Micro-ECoG electrodes, manufactured with a novel laser technology

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

Intraosseous Schwannoma of the Left Infra Temporal Region Involving Oral Cavity: A Case Report

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