Facial nerve function after large cystic vestibular schwannomas surgery via the retrosigmoid approach

Wang, Qingwen; Jia, Donglin; Shen, Jie; Zhang, Jian; Li, Gang

doi:10.5137/1019-5149.jtn.5910-12.1

Cited by 8 publications

(13 citation statements)

References 20 publications

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“…Our study indicates that even in VS with brainstem compression, complete tumor removal with favorable outcome is feasible. [3412172731333435394146474953]…”

Section: Discussionmentioning

confidence: 99%

“…However, patients with large or giant VS additionally suffer from other symptoms: The trigeminal nerve is affected in 40–80% of patients and the facial nerve is affected in 10–20% of patients. [2325394649] Further, impaired vestibular function and cerebellar and brainstem compression lead to gait instability and long tract signs in 30–50% of patients. [253949] Clinical symptoms of intracranial hypertension include papilledema and abducens nerve palsy.…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with other studies of large VS, the incidence of cystic changes in our patient cohort was 18% in type 4a and 37% in type 4b. [13204246] Cystic VS are associated with shorter symptomatic periods before presentation and an unpredictable growth velocity. The presence of a cyst may be associated with rapid expansion of the lesion, brainstem compression, and hydrocephalus associated with neurologic symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of a cyst may be associated with rapid expansion of the lesion, brainstem compression, and hydrocephalus associated with neurologic symptoms. [13204246]…”

Section: Discussionmentioning

confidence: 99%

“…[5111724304353] The retrosigmoid approach is the most popular approach among neurosurgeons. [19162532383940465051] It is fast, straightforward, and offers excellent visualization of the CPA [Figure 5], trigeminal nerve, lower cranial nerves, and majority of the posterior fossa arteries including the upper part of the vertebral artery, a high origin of the posterior inferior cerebellar artery, and distal parts the anterior inferior cerebellar artery and superior cerebellar artery. [37] Some authors have pointed out that the visualization of the internal acoustic canal (IAC) may be limited in the retrosigmoid approach.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Harati¹,

Scheufler²,

Schultheiß³

et al. 2017

Surg Neurol Int

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Background:Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression.Methods:Forty-nine patients presented with VS (Hannover grading scale T4a or T4b) in our department. A subgroup analysis was performed among patients without (T4a) and with (T4b) compression and dislocation of the fourth ventricle.Results:Patients with type T4b VS presented significantly more often with long tract signs/ataxia (P < 0.05), tonsillar herniation (P < 0.001), and preoperative hydrocephalus (P < 0.01). No significant difference was found between the groups regarding hearing loss and facial nerve, trigeminal nerve, and lower cranial nerve function. Gross total resection was achieved in 83% of the cases, near total resection was achieved in 15% of the cases, and subtotal resection was performed in 2% of the cases. One patient died after massive postoperative bleeding caused by a coagulopathy. At last follow-up, 69% of the patients had excellent facial nerve function (Grade I–II) and the remaining 31% a fair outcome. Six patients (12%) required permanent ventriculoperitoneal shunting. Hearing was preserved in two patients. Forty-six patients (94%) were independent without occasional assistance (Karnofsky scale 70–100%).Conclusions:VS with brainstem compression is frequently associated with hydrocephalus, ataxia, long tract signs, multiple cranial nerve disorders, and occasionally, signs of intracranial hypertension. Primary microsurgical resection is an appropriate management option for large VS.

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“…Our study indicates that even in VS with brainstem compression, complete tumor removal with favorable outcome is feasible. [3412172731333435394146474953]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The presence of a cyst may be associated with rapid expansion of the lesion, brainstem compression, and hydrocephalus associated with neurologic symptoms. [13204246]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Harati¹,

Scheufler²,

Schultheiß³

et al. 2017

Surg Neurol Int

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Comparison of surgical outcomes in cystic and solid vestibular schwannomas: a systematic review and meta-analysis

Song

Wang

et al. 2020

Neurosurg Rev

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Management von Patienten mit Vestibularisschwannomen Typ IV

Harati

Oni

Schultheiß

et al. 2020

Laryngorhinootologie

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Zusammenfassung Hintergrund Vestibularisschwannome (VS) sind benigne Tumoren, die anhand der Hannover-Klassifikation bzw. der Koos-Klassifizierung eingeteilt werden. Trotz der umfangreichen Literatur sind die Klinik und die Behandlungskonzepte speziell bei großen VS selten beschrieben. Material und Methoden Zwischen 2003 und 2018 wurden 61 Patienten mit VS Typ IV durch die Arbeitsgruppe Schädelbasischirurgie am Klinikum Dortmund behandelt. Die radiologischen und klinischen Daten wurden retrospektiv ausgewertet. Zudem erfolgte eine Subgruppenanalyse zwischen Patienten mit und ohne Kompression des IV. Ventrikels. Ergebnisse Neben einer Hörminderung bei 55 Patienten (90 %) hatten die meisten Patienten multiple Symptome wie eine Trigeminusaffektion bei 16 (26 %), eine Fazialisparese bei 7 (12 %), eine Ataxie bei 27 (45 %) und Symptome eines Hirndruckanstiegs durch einen Hydrozephalus bei 4 Patienten (7 %). Bei Patienten mit einem VS Typ IVb wurde signifikant häufiger eine Ataxie, eine tonsilläre Herniation bzw. ein Hydrozephalus festgestellt. Eine komplette Resektion wurde in 48 Patienten (78 %) erreicht und eine weitestgehende Tumorentfernung in 12 Patienten (20 %). In der Langzeituntersuchung zeigten 90 % einen günstigen Outcome bezüglich des Nervus facialis (House-und-Brackman-Grad I–III). 6 Patienten (10 %) benötigten einen dauerhaften ventrikulo-peritonealen Shunt. Mehr als 90 % der Patienten erzielten einen Karnofsky-Index > 70 %. Diskussion VS Typ IV sind häufig assoziiert mit Hydrozephalus, Ataxie, multiplen Hirnnervenausfällen und gelegentlich Zeichen eines intrakraniellen Druckanstiegs. Die primäre mikrochirurgische Resektion ist weiterhin eine entscheidende Therapieoption.

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Facial nerve function after large cystic vestibular schwannomas surgery via the retrosigmoid approach

Cited by 8 publications

References 20 publications

Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Comparison of surgical outcomes in cystic and solid vestibular schwannomas: a systematic review and meta-analysis

Management von Patienten mit Vestibularisschwannomen Typ IV

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