Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas

Grahnke, Kurt; Garst, Jonathan; Martin, Brendan; Leonetti, John; Anderson, Douglas E.

doi:10.1055/s-0037-1604077

Cited by 11 publications

(14 citation statements)

References 41 publications

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“…Beyond tumor size, other tumor configuration characteristics, such as anterior tumor extension, may predict worse FN function because the nerve can become stretched and splayed and therefore more susceptible to dissection or traction injury. 17,43,45,46 While this study did not find a significant association between tumor size and latest FN function, future studies should probe the effects of tumor configuration features in more detail. Microsurgery has evolved to prioritize preservation of neurologic function over maximal GTR, especially with the possibility for magnetic resonance imaging surveillance and radiation treatment of residual tumor, should any growth occur.…”

Section: Predictive Factors Of Fn Functional Outcomescontrasting

confidence: 71%

“…[10][11][12][13] Reported incidence of FN dysfunction after VS resection is variable, with a number of clinical factors noted to influence outcomes. 7,[14][15][16][17] Larger tumor size has traditionally been associated with poorer FN results. 16,[18][19][20][21][22][23][24][25] This may be due to greater tumor adhesion and nerve splaying, making FN identification difficult and thus increasing the likelihood of nerve injury.…”

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confidence: 99%

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Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Ren

MacDonald

Tawfik

et al. 2020

Otolaryngol.--head neck surg.

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Objective To identify clinical predictors of facial nerve (FN) outcomes after microsurgical resection of vestibular schwannoma (VS). Study Design Prospective cohort study. Setting Academic medical center. Methods Consecutive patients undergoing VS resection from November 2017 to October 2019 were included. FN function was evaluated with the House-Brackmann (HB) scale and stratified into good (HB I-II) and poor (HB III-VI) function. Analyses included descriptive statistics, correlation, and logistic regression. Results Of 256 patients who met criteria (mean age, 47.7 years; 62.5% female), 227 (88.7%) achieved good FN function postoperatively and 238 (93.0%) at latest follow-up (mean, 154.8 days). Operative approaches consisted of translabyrinthine (50.8%), retrosigmoid (25.0%), and middle fossa craniotomies (24.2%). Extent of resection was decided intraoperatively, and gross or near total resection was accomplished in 237 (92.6%) cases. Postoperative HB grade correlated with latest HB grade (0.615, P < .001). Factors associated with good postoperative FN function included small tumor size (≤15 mm; odds ratio [OR], 2.425; P = .042), gross or near total resection (OR, 3.170; P = .041), and ≥100-µV intraoperative FN electromyographic response to a 0.05-mA stimulus (OR, 22.242; P < .001). Factors associated with good FN function at latest follow-up included gross total resection (OR, 7.764; P = .003) and ≥100-µV FN electromyographic response (OR, 8.518; P < .001), accounting for surgical approach and tumor size. Conclusion Microsurgical resection of VS can be accomplished with excellent FN outcomes. Gross total resection and ≥100-µV intraoperative FN electromyographic response predicted excellent FN outcomes. Immediate postoperative FN function is a prognosticator of long-term FN function.

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Section: Predictive Factors Of Fn Functional Outcomescontrasting

confidence: 71%

mentioning

confidence: 99%

Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Ren

MacDonald

Tawfik

et al. 2020

Otolaryngol.--head neck surg.

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“…One risk is that of facial paralysis, a potentially devastating outcome that has been demonstrated to result in psychological distress 1 and decreased quality of life (QOL). 2 The risk of facial paralysis following surgical resection has been correlated with previous radiation therapy, increasing tumor size, [3][4][5][6] tumor position, 7 and direction of tumor growth. [7][8][9][10] With increasing tumor size, the facial nerve can become displaced, compressed, splayed across, or adherent to the surface of the tumor.…”

Section: Introductionmentioning

confidence: 99%

“…2 The risk of facial paralysis following surgical resection has been correlated with previous radiation therapy, increasing tumor size, [3][4][5][6] tumor position, 7 and direction of tumor growth. [7][8][9][10] With increasing tumor size, the facial nerve can become displaced, compressed, splayed across, or adherent to the surface of the tumor. Anatomically, the facial nerve lies in the anterior-superior quadrant of the internal auditory canal (IAC).…”

Section: Introductionmentioning

confidence: 99%

Vestibular Schwannoma Cerebellopontine Angle Position Impacts Facial Outcome

et al. 2021

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Objectives/Hypothesis To determine the impact of vestibular schwannoma (VS) position relative to the internal auditory canal (IAC) on postoperative facial nerve function and extent of surgical resection. Study Design Retrospective chart review. Methods Retrospective review of patients undergoing resection of large (≥25 mm) VSs. Outcome measures included early (≤1 month) facial function, long‐term (≥1 year) facial function and extent of resection. Tumor measurements included the greatest dimension, dimension anterior to the IAC axis, dimension posterior to the IAC axis, and a ratio of posterior‐to‐anterior dimension (PA ratio). Results A total of 127 patients met inclusion criteria. In early follow‐up, 60% patients had good (House‐Brackmann I–II), and 40% patients had poor (House‐Brackmann III–VI) facial function. In long‐term follow‐up, 71% patients had good, and 29% patients had poor facial function. A total of 72% of patients underwent gross total resection (GTR) of their tumors. Patients with good facial function had significantly larger PA ratios than patients with poor function both early and long term; however, greatest dimension was the more clearly significant independent predictor of facial outcomes. A larger PA ratio was observed in patients in whom GTR was achieved, but this association was potentially confounded by surgeon preferences and was not statistically significant after controlling for surgical site. Conclusions This study demonstrates that VS position relative to the IAC axis can be used along with tumor size to predict postoperative facial outcomes. A greater proportion of tumor posterior to the IAC axis was associated with significantly better facial outcomes. Level of Evidence 4 Laryngoscope, 132:1093–1098, 2022

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“…11,13 Furthermore, facial nerve weakness has been found to significantly decrease quality of life (QOL). 14-18 Tumor size, as measured by tumor diameter, is a predictor of facial nerve outcome; however, recent evidence suggests that tumor volume may be a more accurate way of assessing VS. 15,19-26…”

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confidence: 99%

Facial Nerve Outcomes After Vestibular Schwannoma Microsurgical Resection in Neurofibromatosis Type 2

Sobieski

Killeen

Barnett

et al. 2020

Otolaryngol.--head neck surg.

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Objective The aim of this study is to investigate facial nerve outcomes after microsurgical resection in neurofibromatosis type 2 (NF2) compared to sporadic tumors. Study Design Single institutional retrospective chart review. Setting Tertiary referral center. Methods All adult patients with NF2 vestibular schwannoma (VS) or sporadic VS who underwent microsurgical resection from 2008 to 2019 with preoperative magnetic resonance imaging (MRI) and 1 year of postsurgical follow-up were included. The primary outcome measure was postoperative House-Brackmann (HB) facial nerve score measured at first postoperative visit and after at least 10 months. Results In total, 161 sporadic VSs and 14 NF2 VSs met inclusion criteria. Both median tumor diameter (NF2, 33.5 mm vs sporadic, 24 mm, P = .0011) and median tumor volume (NF2, 12.4 cm3 vs sporadic, 2.9 cm3, P = .0005) were significantly greater in patients with NF2. The median follow-up was 24.9 months (range, 12-130.1). Median facial nerve function after 1 year for patients with NF2 was HB 3 (range, 1-6) compared to HB 1 (range, 1-6) for sporadic VS ( P = .001). With multivariate logistic regression, NF2 tumors (odds ratio [OR] = 13.9, P = .001) and tumor volume ≥3 cm3 (OR = 3.6, P = .025) were significantly associated with HB ≥3 when controlling for age, sex, extent of tumor resection, translabyrinthine approach, and prior radiation. Conclusion Tumor volume >3 cm3 and NF2 tumors are associated with poorer facial nerve outcomes 1 year following microsurgical resection.

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Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas

Cited by 11 publications

References 41 publications

Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Vestibular Schwannoma Cerebellopontine Angle Position Impacts Facial Outcome

Facial Nerve Outcomes After Vestibular Schwannoma Microsurgical Resection in Neurofibromatosis Type 2

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