Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery

Gerganov, Venelin; Klinge, Petra M.; Nouri, Mohsen; Stieglitz, Lennart; Samii, M.; Samii, Amir

doi:10.1007/s00701-009-0288-3

Cited by 31 publications

(43 citation statements)

References 40 publications

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“…Older patients and those with larger tumors are known to have an increased risk of facial nerve injury after microsurgery. 5,9 In larger tumors extending to the facial nerve, the nerve is at greater risk during surgery and more likely to show intraoperative electrophysiological irritation which, by the treatment methods we described, would lead us to elect an STR. This explains why patients with STR had larger tumors than patients with GTR.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with larger tumors have consistently had worse outcomes than patients with smaller tumors after both radiosurgery and microsurgery. 5,9,21 A patient's facial nerve function before surgery is an important determinant of posttreatment outcome; patients presenting with poor preoperative facial nerve status more often have deterioration of facial nerve function than patients with a better preoperative status. 9 Age may also be an important factor to consider in treating VSs-younger patients have a higher likelihood of facial nerve preservation.…”

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confidence: 99%

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Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Haque

Wojtasiewicz²,

Gigante³

et al. 2011

JNS

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Object. The goal of this article was to show that a combination of facial nerve-sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS).Methods. Records of individuals treated by a single surgeon with a facial nerve-sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.2%) of these patients required postoperative retreatment for a significant expansion of residual tumor after microsurgery. These 20 patients were re-treated with GKS.Results. The rate of preservation of good facial nerve function (Grade I or II on the House-Brackmann scale) in patients treated with microsurgery for VS was 97%. Both subtotal and gross-total resection had excellent facial nerve preservation rates (97% vs 96%), although subtotal resection carried a higher risk that patients would require retreatment. In patients re-treated with GKS after microsurgery, the rate of facial nerve preservation was 95%.Conclusions. In patients with tumors that cannot be managed with radiosurgery alone, a facial nerve-sparing resection followed by GKS for any significant regrowth provides excellent facial nerve preservation rates. (DOI: 10.3171/2011.7.JNS101921) key WoRDs • vestibular schwannoma • facial nerve • Gamma Knife surgery • tumor recurrence • peripheral nerve 917Abbreviations used in this paper: GKS = Gamma Knife surgery; GTR = gross-total resection; HB = House-Brackmann; IAC = internal auditory canal; NF2 = neurofibromatosis Type 2; STR = subtotal resection; VS = vestibular schwannoma.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Haque

Wojtasiewicz²,

Gigante³

et al. 2011

JNS

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“…But the results of some recent studies have not supported these conclusions. 12,14,23 Thus, we hypothesized that not all cystic VSs may have worse surgical outcomes, and some undefined factors originating from cystic VSs might be responsible for these different clinical and surgical courses. Interestingly, we found a subset of cystic VSs presented with fluid-fluid levels, indicating intratumoral hemorrhage, as previously reported.…”

Section: ©Aans 2014mentioning

confidence: 99%

“…2,12,14,23 Lunardi et al 17 believed that aspiration of the cyst content facilitated recognition and preservation of the facial nerve and removal of the solid component, thus ensuring a very good prognosis in all patients. Mehrotra et al 20 found that in cystic VS, facial nerve preservation was higher due to the faster and earlier decompression of the lesion that facilitated its earlier identification.…”

Section: 2127mentioning

confidence: 99%

Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion

Xia¹,

Zhang²,

Yu³

et al. 2014

JNS

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Object. The aim of this study was to evaluate the clinical results and surgical outcomes of cystic vestibular schwannomas (VSs) with fluid-fluid levels.Methods. Forty-five patients with cystic VSs and 86 with solid VSs were enrolled in the study. The patients in the cystic VSs were further divided into those with and without fluid-fluid levels. The clinical and neuroimaging features, intraoperative findings, and surgical outcomes of the 3 groups were retrospectively compared.Results. Peritumoral adhesion was significantly greater in the fluid-level group (70.8%) than in the nonfluidlevel group (28.6%) and the solid group (25.6%; p < 0.0001). Complete removal of the VS occurred significantly less in the fluid-level group (45.8%, 11/24) than in the nonfluid-level group (76.2%, 16/21) and the solid group (75.6%, 65/86; p = 0.015). Postoperative facial nerve function in the fluid-level group was less favorable than in the other 2 groups; good/satisfactory facial nerve function 1 year after surgery was noted in 50.0% cases in the fluid-level group compared with 83.3% cases in the nonfluid-level group (p = 0.038).Conclusions. Cystic VSs with fluid-fluid levels more frequently adhered to surrounding neurovascular structures and had a less favorable surgical outcome. A possible mechanism of peritumoral adhesion is intratumoral hemorrhage and consequent inflammatory reactions that lead to destruction of the tumor-nerve barrier. These findings may be useful in predicting surgical outcome and planning surgical strategy preoperatively. 197Abbreviations used in this paper: DRIVE = driven equilibrium; PICA = posterior inferior cerebellar artery; TSE = turbo spin echo; VS = vestibular schwannoma.

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“…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 .…”

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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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Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery

Abstract: Our data suggests that the analysis of the radiological and neurological patient data prior to surgery could give reliable clues regarding the immediate post-operative facial nerve function.

Cited by 31 publications

References 40 publications

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

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