Facial Nerve Function and Quality of Resection in Large and Giant Vestibular Schwannomas Surgery Operated By Retrosigmoid Transmeatal Approach in Semi-sitting Position with Intraoperative Facial Nerve Monitoring

Boublata, L.; Belahreche, Mohamad; Ouchtati, Rafik; Shabhay, Zarina; Boutiah, Leila; Kabache, Mohamad; Nadji, M'hamed; Djenna, Z.; Bounecer, Hocine; Ioualalen, N.

doi:10.1016/j.wneu.2017.02.053

Cited by 29 publications

(22 citation statements)

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“…The use of monitoring has been shown to improve the outcome of surgery and, when indicating nerve damage, to have also a predictive value in terms of operative outcome [2, 4, 29, Fig. 1 Flow chart of the patient recruitment for the study 2 Diameter and volume are calculated for the extrameatal part of the tumor 3 Koos grading of vestibular schwannoma: 1, intrameatal; 2, extending to the cerebellopontine angle; 3, in contact with the brainstem; 4, compressing the brainstem 4 Hearing is determined according to the WHO classification 5 Drilling of internal acoustic meatus 6 Intraoperative increase in stimulation threshold or loss of response in facial nerve monitoring 7 Postoperative complication requiring re-operation 8 Regrowth during subsequent follow-up leading to intervention ]. In the current study, this predictive value was evident, since in the good outcome group, only two patients exhibited an intraoperative stimulation threshold increase, whereas nearly 70% of patients in the poor outcome group showed signs of facial nerve damage during surgery (Table 2 and Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, hearing is impaired in most patients already before surgery. However, in patients with good initial hearing and small tumor size, up to over 60% have been reported to have good or serviceable postoperative hearing [32], whereas in larger 2 Koos grading of vestibular schwannoma: 1, intarmeatal; 2, extending to the cerebellopontine angle; 3, in contact with the brainstem; 4, compressing the brainstem 3 Drilling in internal acoustic meatus 4 Complication requiring re-operation 5 Regrowth leading to reoperation or radiosurgery 6 Facial nerve outcome at 12 months by House-Brackman grade (1-2 good, 3-4 moderate, 5-6 poor) 7 Hearing is determined according to the WHO classification tumors the percentage is far lower especially if hearing is affected already preoperatively [59]. In the current study, hearing was impaired in most patients already preoperatively and only 23.8% had normal hearing on the affected side.…”

Section: Discussionmentioning

confidence: 99%

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Facial nerve function and hearing after microsurgical removal of sporadic vestibular schwannomas in a population-based cohort

et al. 2019

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Background Vestibular schwannoma (VS) is a benign tumor originating from the vestibulocochlear nerve. The optimal treatment strategy is debated, since surgery may result in iatrogenic facial nerve injury. We report the results of VS surgery in a populationbased unselected cohort in a center with access to Cyber Knife (CK) radiosurgery. Methods We reviewed 117 consecutive operations and found 95 patients who had their primary operation due to vestibular schwannoma between 2001 and 2017. Facial nerve function was evaluated with the House-Brackmann (HB) scale and hearing with the EU classification. Results The population consisted of 37 males and 58 females with a median age of 54 years (range 19-79). One year after surgery 67% of patients had a good outcome (HB 1-2). The rate of good outcome was 90% if no facial nerve damage was observed during intraoperative monitoring, the size of the tumor was under 30 mm and no hydrocephalus was present. During the study period, the treatment strategy changed from total to near-total resection after the introduction of CK radiosurgery, which could be used as a second-line treatment in case of residual tumor regrowth. This resulted in an improvement of outcomes (0% HB 5-6) despite the larger tumor sizes (25 ± 14 mm vs. 31 ± 9 mm, p < 0.05). Hearing preservation rates did not increase. Conclusions Near-total resection and subsequent CK radiosurgery in case of residual tumor regrowth during follow-up seems to provide a good outcome of facial nerve function even in large VSs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Facial nerve function and hearing after microsurgical removal of sporadic vestibular schwannomas in a population-based cohort

et al. 2019

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“…The pooled overall GTR rate was 77% (95% CI 70.6–83.3%) in large series of large VS (Fig. 1 ) [ 2 , 13 , 14 , 17 , 19 , 25 , 26 , 30 , 33 – 35 , 47 , 64 , 66 , 76 , 77 , 88 , 97 , 99 , 100 , 104 , 109 , 119 , 134 , 137 , 138 , 142 , 145 , 147 , 152 , 156 , 160 , 161 , 166 , 169 , 177 , 180 , 181 , 186 – 190 ]. Notably, high-volume hospitals and surgeon caseload have been associated with decreased mortality, decreased postoperative complications and readmission rate, and better oncological and functional outcome [ 7 , 8 ] (Fig.…”

Section: Growth Pattern and Measurement Of Tumor Sizementioning

confidence: 99%

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

et al. 2020

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Background and objective The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. Material and methods A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. Results Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. Conclusion The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.

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“…The retrosigmoid approach is frequently used and seems to be useful with regard to radical resection and facial nerve function-preserving resection in VS [7,40]. Furthermore, middle fossa [34] or translabyrinthine approaches can also be applied [3,9,35].…”

Section: Introductionmentioning

confidence: 99%

The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery

et al. 2020

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Background Facial nerve palsy is a severe morbid condition that occurs after vestibular schwannoma (VS) surgery. The objective of this study was to evaluate facial nerve outcomes based on surgical techniques, tumour size, and immunohistochemical factors. Methods One hundred eighteen patients with VS were retrospectively analysed. Gross total resection (GTR) was achieved in 83 patients, and subtotal resection (STR) was achieved in 35 patients. Follow-up was 60 months (median). Facial nerve outcomes were assessed for 24 months after surgery. Analysis of the MIB-1 index was performed in 114 patients (97%) to evaluate recurrence and facial nerve outcomes. Results Immediately after surgery, 16 of 35 patients (45.7%) with STR and 21 of 83 patients (25.3%) with GTR had a good (House-Brackmann (HB) score ≤ 2) facial nerve outcome (p = 0.029). Semi-sitting positioning (p = 0.002) and tumour size class of 3 (> 4 cm) were also associated with worse HB outcomes after 2 years (p = 0.004) in univariate analyses. The MIB-1 index was significantly correlated with diffuse infiltration of tumour-associated CD45 + lymphocytes (r = 0.63, p = 0.015) and CD68 + macrophages (r = 0.43, p = 0.021). ROC analysis found an AUC of 0.73 (95% CI = 0.60-0.86, p = 0.003) for the MIB-1 index in predicting poor facial nerve outcomes. Binary logistic regression analysis revealed an MIB-1 index ≥ 5% (16/28 (57.1%) vs. 5/ 40 (12.5%); p < 0.001, OR = 14.0, 95% CI = 3.2-61.1) and a tumour size class of 3 (6/8 (75.0%) vs. 2/8 (25.0%); p = 0.01, OR = 14.56, 95% CI = 1.9-113.4) were predictors of poor HB scores (≥ 3) after 1 year. Conclusions An MIB-1 index ≥ 5% seems to predict worse long-term facial nerve outcomes in VS surgery.

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Facial Nerve Function and Quality of Resection in Large and Giant Vestibular Schwannomas Surgery Operated By Retrosigmoid Transmeatal Approach in Semi-sitting Position with Intraoperative Facial Nerve Monitoring

Cited by 29 publications

References 20 publications

Facial nerve function and hearing after microsurgical removal of sporadic vestibular schwannomas in a population-based cohort

Facial nerve function and hearing after microsurgical removal of sporadic vestibular schwannomas in a population-based cohort

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery

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