Facial Nerve Grading System 2.0

Vrabec, Jeffrey T.; Backous, Douglas D.; Djalilian, Hamid R.; Gidley, Paul W.; Leonetti, John; Marzo, Sam J.; Morrison, Daniel R.; Ng, Michael K.; Ramsey, Mitchell J.; Schaitkin, Barry M.; Smouha, Eric E.; Toh, Elizabeth H.; Wax, Mark K.; Williamson, R. Anthony; Smith, E O

doi:10.1016/j.otohns.2008.12.031

Cited by 176 publications

(84 citation statements)

References 11 publications

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“…MR imaging was performed to exclude a neoplastic cause of facial palsy. Initial House-Brackmann grade 22 was II in 6 patients, III in 12, IV in 16, and V in 2.…”

Section: Patientsmentioning

confidence: 96%

MR Diagnosis of Facial Neuritis: Diagnostic Performance of Contrast-Enhanced 3D-FLAIR Technique Compared with Contrast-Enhanced 3D-T1-Fast-Field Echo with Fat Suppression

Lim¹,

Lee²,

Hyun³

et al. 2011

AJNR Am J Neuroradiol

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“…MR imaging was performed to exclude a neoplastic cause of facial palsy. Initial House-Brackmann grade 22 was II in 6 patients, III in 12, IV in 16, and V in 2.…”

Section: Patientsmentioning

confidence: 96%

MR Diagnosis of Facial Neuritis: Diagnostic Performance of Contrast-Enhanced 3D-FLAIR Technique Compared with Contrast-Enhanced 3D-T1-Fast-Field Echo with Fat Suppression

Lim¹,

Lee²,

Hyun³

et al. 2011

AJNR Am J Neuroradiol

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“…Good facial function was defined as House-Brackmann Grade I or II. 24 The median follow-up for all patients included in this analysis was 46 months (range 2-259 months).…”

Section: Clinical and Neuroimaging Follow-upmentioning

confidence: 99%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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ABBREVIATIONS CN = cranial nerve; CPA = cerebellopontine angle; EMG = electromyography; EOR = extent of resection; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; IAC = internal auditory canal; STR = subtotal resection; TTP = time to progression. SUBMITTED August 3, 2016 OBJECTIVE Advanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC). METHODS Medical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve-sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated. RESULTS According to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes. CONCLUSIONS CPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass ef...

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“…In this report we analyzed the facial nerve function in patients initially treated with microsurgery. We analyzed the outcomes of patients treated with the facial nervesparing technique, recording the following: facial nerve function before and after treatment (using the modified HB scale 20 ); any morbidity associated with the procedure, such as CSF leaks and hydrocephalus; and whether further treatment was needed to control tumor growth. Our findings in this patient set ascertained the efficacy of a dedicated, facial nerve-sparing microsurgical approach in treating patients with VS.…”

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confidence: 99%

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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Facial Nerve Grading System 2.0

Abstract: FNGS 2.0 incorporates regional scoring of facial movement, providing additional information while maintaining agreement comparable to the original scale. Ambiguities regarding use of the grading scale are addressed.

Cited by 176 publications

References 11 publications

MR Diagnosis of Facial Neuritis: Diagnostic Performance of Contrast-Enhanced 3D-FLAIR Technique Compared with Contrast-Enhanced 3D-T1-Fast-Field Echo with Fat Suppression

MR Diagnosis of Facial Neuritis: Diagnostic Performance of Contrast-Enhanced 3D-FLAIR Technique Compared with Contrast-Enhanced 3D-T1-Fast-Field Echo with Fat Suppression

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

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

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