Prediction of postoperative facial nerve function in acoustic neuroma surgery

Fenton, John E.; Chin, R; Shirazi, Alireza; Fagan, Paul

doi:10.1046/j.1365-2273.1999.00287.x

Cited by 45 publications

(37 citation statements)

References 8 publications

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“…Although tumor size alone should not be considered as a predictive factor, it has been thought to be the most important one 9,10 . Gormley 28 showed that 96% of patients with small tumors had postoperatively normal facial function or slight dysfunction (Grade I-II), whereas only 38% of patients with tumors greater than 4.0 cm had no dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that tumor size is an approximate guide to predicting ultimate functional outcome 9,10 . The objective of this study is to analyze the facial nerve function in patients submitted to VS surgery by the retrosigmoid transmeatal approach and correlate tumor size with the grade of postoperative facial palsy (FP).…”

Section: Dra Rafaela Júlia Batista Veronezi -Rua Santaré� Qd 235 Lt mentioning

confidence: 99%

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Long-term facial nerve clinical evaluation following vestibular schwannoma surgery

Veronezi

Fernandes

Borges

et al. 2008

Arq. Neuro-Psiquiatr.

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-Background: Facial function is important in accompaniment of patients operated on vestibular schwannoma (VS). Objetive: To evaluate long term facial nerve function in patients undergoing VS resection and to correlate tumor size and facial function in a long-term follow-up. Method: Transversal study of 20 patients with VS operated by the retrosigmoid approach. House-Brackmann Scale was used preoperatively, immediately after surgery and in a long-term follow-up. Student t test was applied for statistic analysis. Results: In the immediate postoperative evaluation, 65% of patients presented FP of different grades. Improvement of facial nerve function (at least of one grade) occurred in 53% in the long-term follow-up. There was statistically significant difference in facial nerve outcome in long-term follow-up when tumor size was considered (p<0.05). Conclusion: The majority of patients had improvement of FP in a long-term follow-up and tumor size was detected to be a factor associated with the postoperative prognostic.Key wordS: vestibular schwannoma, facial nerve function, retrosigmoid approach. Avaliação clínica tardia do nervo facial no pós-operatório de schwannoma vestibularResumo -Contexto: A função facial é importante para acompanhamento dos pacientes operados de schwannoma vestibular (SV). Objetivo: Avaliar o grau de paralisia facial (PF) em pacientes operados de SV, correlacionando tamanho do tumor com função facial na avaliação tardia. Método: estudo transversal com análise seriada de 20 pacientes com SV operados pela via retrosigmóide-transmeatal. A escala de House-Brackmann foi utilizada no pré-operatório, pós-operatório imediato e pós-operatório tardio. o teste t de Student foi aplicado para análise estatística. Resultados: No pós-operatório imediato, 65% dos pacientes apresentaram graus variados de PF, sendo que 53% destes obtiveram melhora de pelo menos um grau de House-Brackmann na avaliação tardia. Houve diferença significativa no resultado da função facial no pós-operatório tardio quando o tamanho do tumor foi considerado (p<0.05). Conclusão: A maioria dos pacientes da amostra apresentou melhora da PF no pós-operatório tardio, sendo o tamanho do tumor um fator associado ao prognóstico.PAlAVrAS-cHAVe: schwannoma vestibular, função facial, via retrosigmóide.

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Section: Discussionmentioning

confidence: 99%

Section: Dra Rafaela Júlia Batista Veronezi -Rua Santaré� Qd 235 Lt mentioning

confidence: 99%

Long-term facial nerve clinical evaluation following vestibular schwannoma surgery

Veronezi

Fernandes

Borges

et al. 2008

Arq. Neuro-Psiquiatr.

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“…14) Tumor size is the most important predictor of facial nerve palsy. 6) Other predictors of facial nerve function are displacement of the fourth ventricle, image heterogeneity (necrosis, edema, cystic change), and the threshold stimulus eliciting a facial nerve response. 4) H. J. Seol et al…”

Section: Facial Nerve Preservationmentioning

confidence: 99%

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Seol

Kim

Park

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. The extent of resection was classified as follows: gross total resection (GTR), near total resection (NTR), and subtotal resection (STR). Facial nerve function was graded using the modified House-Brackmann grade, and patients grouped into good (grades 1-2) and intermediate or poor (grades 3-6). Of the 116 patients, 26 (22%) underwent GTR, 32 (28%) NTR, and 58 (50%) STR. The recurrence rates were 3.8% (1/26 cases), 9.4% (3/32), and 27.6% (16/58) for GTR, NTR, and STR, respectively. GTR and NTR showed no statistically significant difference in terms of recurrence rate (p ＝ 0.620). However, recurrence was significantly less after NTR than STR (p ＝ 0.043). Immediately postoperative facial nerve function was good in 15.4% of patients after GTR, 40.6% after NTR, and 46.6% after STR. The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p ＝ 0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p ＝ 0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.

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“…27 In the present study, we investigated a method of hypoglossal-facial nerve anastomosis through an NT3-expressing PNG engineered by lentiviral vectors to treat complete facial palsy in adult rats. Since surgical treatment for facial palsy in humans is usually performed with a delay between trauma and repair, 9,36 facial nerve reconstruction in our study was performed either immediately after facial nerve injury or 9 weeks posttrauma. After a minimum of 4 months of postsurgical recovery, the outcomes of different treatments were assessed in the animals via functional, electrophysiological, and histological examinations.…”

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confidence: 99%

Combination of hypoglossal-facial nerve surgical reconstruction and neurotrophin-3 gene therapy for facial palsy

Wan

Zhang

Blanchard

et al. 2013

JNS

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Object Facial nerve injury results in facial palsy that has great impact on the psychosocial conditions of affected patients. Reconstruction of the facial nerve to restore facial symmetry and expression is still a significant surgical challenge. In this study, the authors assessed a hypoglossal-facial nerve anastomosis method combined with neurotrophic factor gene therapy to treat facial palsy in adult rats after facial nerve injury. Methods Surgery consisted of the interposition of a predegenerated nerve graft (PNG) that was anastomosed with the hypoglossal and facial nerves at each of its extremities. The hypoglossal nerve was cut approximately 50% for this anastomosis to conserve partial hypoglossal function. Before their transplantation, the PNGs were genetically engineered using lentiviral vectors to induce overexpression of the neurotrophic factor neurotrophin-3 (NT-3) to improve axonal regrowth in the reconstructed nerve pathway. Reconstruction was performed after facial nerve injury, either immediately or after a delay of 9 weeks. The rats were followed up for 4 months postoperatively, and treatment outcomes were then assessed. Results Compared with the functional innervation in control rats that underwent facial nerve injury without subsequent treatment, functional innervation of the paralyzed whisker pad by hypoglossal motoneurons in rats treated 4 months after nerve reconstruction was evidenced by the retrograde transport of neuronal tracers, the recording of muscle action potentials conducted by the PNG, and the recovery of facial symmetry. Although a better outcome was observed when reconstruction was performed immediately after facial nerve injury, reconstruction with NT3-treated PNGs significantly improved functional reinnervation of the paralyzed whisker pad even when implantation occurred 9 weeks posttrauma. Conclusions Results demonstrated that hypoglossal-facial nerve anastomosis facilitates innervation of paralyzed facial muscle via hypoglossal motoneurons without sacrificing ipsilateral hemitongue function. Neurotrophin-3 treatment through gene therapy could effectively improve such innervation, even after delayed reconstruction. These findings suggest that the combination of surgical reconstruction and NT-3 gene therapy is promising for its potential application in treating facial palsy in humans.

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Prediction of postoperative facial nerve function in acoustic neuroma surgery

Cited by 45 publications

References 8 publications

Long-term facial nerve clinical evaluation following vestibular schwannoma surgery

Long-term facial nerve clinical evaluation following vestibular schwannoma surgery

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Combination of hypoglossal-facial nerve surgical reconstruction and neurotrophin-3 gene therapy for facial palsy

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