Histological acoustic tumor involvement of the viith nerve and multicentric origin in the viiith nerve

Luetje, Charles M.; Whittaker, C. Keith; Callaway, L A; Veraga, G

doi:10.1288/00005537-198309000-00004

Cited by 51 publications

(25 citation statements)

References 12 publications

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“…Our figures for residual tumor follow the criterion that the MRI image with a round profile and nodular mass 13.2% (7/53) in the group with a follow-up of 3 years or less and 2.1% (1/46) in the group with a follow-up more than 3 years. Most of the tumor-positive findings were in the group with a 5-to 7-year postoperative interval.…”

Section: Resultssupporting

confidence: 72%

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Residual and Recurrent Acoustic Neuroma in Hearing Preservation Procedures: Neuroradiologic and Surgical Findings

Mazzoni¹,

Calabrese²,

Moschini³

1996

Skull Base

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Hearing preservation procedures in acoustic neuroma surgery entail a risk of recurrent tumor either from the preserved cochlear nerve (tumor cell remains or late degeneration) or from tumor remnants left in the lateral end of the internal auditory canal. There is disagreement about the frequency of such tumor remnants, and the diagnostic modalities are not precise. Magnetic resonance imaging with gadolinium-DTPA enhancement is effective in diagnosing a primary case, but may not be so clear for small residual or recurrent tumors. A review of the literature concerning residual/recurrent tumor after "total" removal in functional unilateral acoustic neuroma surgery provided several reports,1-9 but systematic studies were lacking.This study of a series of 104 acoustic neuroma cases operated on with a hearing preservation procedure assessed the rates of residual or recurrent tumor and the imaging data that were significant for its diagnosis. MATERIALS AND METHODSDuring the period 1975 to 1993, 104 consecutive patients presenting with acoustic neuroma were operated on with the same hearing preservation procedure: the suboccipital approach with meatotomy and direct exposure of the lateral end of the internal auditory canal (IAC). The procedure involved a bone resection of the posterior and part of the superior and inferior walls of the IAC and used as landmarks the vestibular aqueduct, the common crus, and the nonampullated crura of the posterior and the superior semicircular canals. In every case, the surgeon 105

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Section: Resultssupporting

confidence: 72%

“…Four patients presented a linear enhancement on the walls of the meatotomy (nos. 11,12,13) or along the course of the acoustico-facial bundle (no. 4), which did not change at the follow-up MRI 1 year later.…”

Section: Resultsmentioning

confidence: 99%

Residual and Recurrent Acoustic Neuroma in Hearing Preservation Procedures: Neuroradiologic and Surgical Findings

Mazzoni¹,

Calabrese²,

Moschini³

1996

Skull Base

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“…However, the cisternal arachnoid membranes anatomy and its relationship with cranial nerves are controversial, especially because of the difficulty preserving the membranes on cadaveric specimens. The epiarachnoid or subarachnoid origin of VS has been subject of discussion and the presence of an arachnoid surgical plane between tumor and cranial nerves questioned by some authors 17,18,19,20,21,22,23,24,25 . This is not what we have experienced during the surgical procedures, where the arachnoid membrane is used as a protection to preserve the facial nerve anatomically and functionally.…”

Section: Discussionmentioning

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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“…Nevertheless, studies exist that examine the interface between facial nerve and tumor, and all demonstrate lack of such interface in at least parts of the tumor, if not in all observable parts of the tumor histologically. 51,56 Jääskeläinen et al 51 found that where the facial nerve trunk is attached to the surface of the tumor, nerve fibers in the contact area are either abutted directly against tumor cells or penetrated into the tumor tissue. Because these studies examined the histology of large VSs almost exclusively, they are particularly relevant to the current management paradigm for VS because the larger the tumor, the more likely it becomes a surgical candidate.…”

Section: Tumor-nerve Interface During Vs Surgerymentioning

confidence: 99%

Neuroanatomical correlation of the House-Brackmann grading system in the microsurgical treatment of vestibular schwannoma

Sun

Oh²,

Safaee³

et al. 2012

FOC

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Avoidance of facial nerve injury is one of the major goals of vestibular schwannoma (VS) surgery because functional deficits of the facial nerve can lead to physical, cosmetic, and psychological consequences for patients. Clinically, facial nerve function is assessed using the House-Brackmann grading scale, which also allows physicians to track the progress of a patient's facial nerve recovery. Because the facial nerve is a peripheral nerve, it has the ability to regenerate, and the extent of its functional recovery depends largely on the location and nature of its injury. In this report, the authors first describe the facial nerve anatomy, the House-Brackmann grading system, and factors known to be predictors of postoperative facial nerve outcome. The mechanisms and pathophysiology of facial nerve injury during VS surgery are then discussed, as well as factors affecting facial nerve regeneration after surgery.

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Histological acoustic tumor involvement of the viith nerve and multicentric origin in the viiith nerve

Cited by 51 publications

References 12 publications

Residual and Recurrent Acoustic Neuroma in Hearing Preservation Procedures: Neuroradiologic and Surgical Findings

Residual and Recurrent Acoustic Neuroma in Hearing Preservation Procedures: Neuroradiologic and Surgical Findings

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

Neuroanatomical correlation of the House-Brackmann grading system in the microsurgical treatment of vestibular schwannoma

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