Preservation of vestibular nerves in surgery of the cerebellopontine angle: Effect on hearing and balance function

Prasad, Sanjay; Kamerer, Donald B.; Hirsch, Barry E.; Sekhar, Laligam N.

doi:10.1016/0196-0709(93)90004-q

Cited by 29 publications

(5 citation statements)

References 7 publications

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“…Patients with less preoperative vestibular function would be better compensated and would, therefore, be better able to deal with surgical deafferentation. Of note is that following a retrosigmoid approach, it is not uncommon for some degree of vestibular function to be preserved as either the superior or inferior vestibular nerves may be spared 37–39. Few authors have reported vestibular comorbidities that may contribute to balance dysfunction following surgery.…”

Section: Factors That Affect Vestibular Compensationmentioning

confidence: 99%

A contemporary review of balance dysfunction following vestibular schwannoma surgery

2009

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Objectives/Hypothesis: This review aims to evaluate the literature pertaining to subjective balance dysfunction following vestibular schwannoma surgery; the effect of postoperative imbalance on disability, handicap and quality of life; and to determine factors that influence vestibular compensation.Methods: Ovid MEDLINE, Cochrane databases, and relevant contemporary texts were searched for papers relating to subjective balance dysfunction following vestibular schwannoma surgery. The quality of this clinical evidence was evaluated.Results: The search yielded 26 studies assessing subjective balance dysfunction following vestibular schwannoma surgery. Analysis revealed that the majority of patients complain of balance dysfunction following surgery; however, a small number report disability or handicap. A few studies have demonstrated a decreased quality of life due to balance dysfunction. Factors have been identified that may contribute to a poor recovery.Conclusions: Further study is needed of the factors that influence vestibular compensation following vestibular schwannoma surgery. This will help to counsel patients prior to surgery and develop strategies for rehabilitation.

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Section: Factors That Affect Vestibular Compensationmentioning

confidence: 99%

A contemporary review of balance dysfunction following vestibular schwannoma surgery

2009

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“…[ 1 ] Surgical resection is the mainstream therapeutic option for these entities, and cranial nerve damage is a common complication following CPA surgery. [ 2 , 3 ] Patients may develop facial nerve paralysis immediately after surgery or may develop an early delayed postoperative paralysis, which severely impairs the individual's quality of life. Currently, various modalities of intraoperative facial nerve mapping and monitoring have been developed for the anatomical and functional preservation of the facial nerve.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of transcranial facial nerve motor-evoked potentials in predicting facial nerve function following cerebellopontine angle tumorectomy

Song¹,

Ma²,

Xu³

et al. 2018

Medicine

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Facial nerve paralysis is a common complication following cerebellopontine angle (CPA) surgery. This study investigated the prognostic value of facial nerve motor-evoked potentials (FNMEPs) elicited by transcranial electrical stimulation for facial nerve outcome after CPA tumorectomy.A total of 95 patients were enrolled in this study between January 2014 and January 2016. All these patients underwent CPA tumorectomy (unilateral, n = 95; bilateral, n = 1). Intraoperative FNMEP elicited by transcranial electrical stimulation was recorded. The short- and long-term postoperative facial nerve functions were evaluated according to the House–Brackmann (HB) scale. The correlation between perioperative changes in the FNMEP stimulus threshold (delta FNMEP = postoperative stimulus threshold level–preoperative stimulus threshold level) and postoperative facial nerve functions were analyzed.On the first day postoperatively, the facial nerve function was HB grade I in 67, grade II in 17, grade III in 7, and grade IV in 5 facial nerves. One year postoperatively, the facial nerve function was grade I in 80, grade II in 11, grade III in 3, and grade IV in 2 facial nerves. The delta FNMEP was significantly correlated with the short- and long-term facial nerve function; receiver operating characteristic (ROC) curves yielded a cut-off delta FNMEP value of 30 V (sensitivity, 91.3%; specificity, 98.6%) and 75 V (sensitivity, 100%; specificity, 98.8%) for predicting short- and long-term facial nerve function damage, respectively.FNMEP elicited by transcranial electrical stimulation is an effective and safe approach for predicting facial nerve function in CPA tumorectomy. A high delta FNMEP is a potential indicator for the prediction of postoperative facial nerve damage.

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“…To the best of our knowledge, clinical presentation and postoperative outcome have not been differentiated according to this classification. Our results indicate that premeatally and retromeatally originating tumors represent different surgical and clinical entities because the relationship between critical neurovascular structures and the tumor is distinctly different 1‐13,18,19 …”

Section: Impact Of Premeatal and Retromeatal Tumor Location On Audito...mentioning

confidence: 85%

“…An extensive critical review of the pertinent literature 4,9‐12 indicates varying results of hearing preservation after removal of CPA meningiomas, but the cause of this variability of postoperative auditory function is not explained. In the first place the size of the tumor might be considered an important causal factor, but unfortunately there is a lack of information about this aspect in most of the reports.…”

Section: Auditory Functionmentioning

confidence: 99%

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Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas

Schaller

Heilbronner

Pfaltz

et al. 1995

Otolaryngol.--head neck surg.

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Preoperative and postoperative facial nerve and auditory function were reviewed retrospectively in 13 cases of cerebellopontine angle meningiomas. According to their location within the posterior fossa and with special reference to the internal auditory canal, they were classified into a premeatal and a retromeatal group. All the tumors were removed by an otoneurosurgical team by use of a retrosigmoid approach. Postoperative results (1 year after operation) were compared within the two groups with respect to preservation of hearing (normal hearing in 31% and preservation of preoperative hearing in 69% of the cases) and facial nerve function (no or mild postoperative impairment in 69% of the cases). Both preoperative and postoperative impairment of facial nerve and auditory function prevailed in the premeatal group. For preservation of vital vascular and central nervous structures, subtotal resection with consecutive fractionated radiation therapy had to be performed in 30% of the cases. Our results provide substantial evidence that in cerebellopontine angle meningiomas a precise preoperative study of tumor location will assist in improving individual operative strategy and thus postoperative functional results.

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Preservation of vestibular nerves in surgery of the cerebellopontine angle: Effect on hearing and balance function

Cited by 29 publications

References 7 publications

A contemporary review of balance dysfunction following vestibular schwannoma surgery

A contemporary review of balance dysfunction following vestibular schwannoma surgery

Prognostic value of transcranial facial nerve motor-evoked potentials in predicting facial nerve function following cerebellopontine angle tumorectomy

Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas

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