Stripping surgery in facial nerve schwannomas with favorable facial nerve function

Sun, Yehuan; Xing, Bo; Han, Shaolong; Li, Tao; Guo, Zheng; Wang, Daowen; Tao, Rui

doi:10.1016/j.amjoto.2015.03.003

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…The concept of ''stripping surgery'' has recently been gaining popularity. [8][9][10][11][12] This is performed by finding a microscopic plane between the tumor and normal neural fascicles to separate them, making it possible to completely resect the tumor while preserving nerve function. It is not always possible to find this plane, in which case a decompression or subtotal resection could be performed.…”

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confidence: 99%

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Facial Schwannoma Management Outcomes: A Systematic Review of the Literature

Bartindale

Heiferman

Joyce

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management. Data Sources PubMed–National Center for Biotechnology Information and Scopus databases. Review Methods A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment. Results Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, P = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, P = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status. Conclusion The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.

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confidence: 99%

“…The concept of “stripping surgery” has recently been gaining popularity 8–12 . This is performed by finding a microscopic plane between the tumor and normal neural fascicles to separate them, making it possible to completely resect the tumor while preserving nerve function.…”

mentioning

confidence: 99%

Facial Schwannoma Management Outcomes: A Systematic Review of the Literature

Bartindale

Heiferman

Joyce

et al. 2020

Otolaryngol.--head neck surg.

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“…The nerve-sparing tumor resection stripping technique minimizes the risks for facial deficits. [12][13][14] However, Hajjaj and Linthicum found with immunostaining techniques that facial nerve fibers were widely disseminated throughout the tumor in 8 of 23 samples, and even a biopsy of them may likely lead to facial dysfunction. 15 Subtotal resection of facial nerve schwannoma to obtain favorable facial nerve function recovery should be reserved for small tumors and for older patients because this technique has a high recurrence rate in the long run.…”

Section: Discussionmentioning

confidence: 99%

Large Intratemporal Facial Nerve Schwannoma without Facial Palsy: Surgical Strategy of Tumor Removal and Functional Reconstruction

Yetışer

2018

J Neurol Surg A Cent Eur Neurosurg

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Conservative treatment with sparing of the nerve is considered in patients with small tumors. Excision of a large facial schwannoma with immediate hypoglossal nerve grafting as a primary procedure can provide satisfactory facial nerve function. One of the disadvantages of performing anastomosis is that there is not enough neural tissue just before the bifurcation of the main stump to provide neural suturing without tension because middle fossa extension of the facial schwannoma frequently involves the main facial nerve at the stylomastoid foramen. Reanimation should be processed with extensive backward mobilization of the hypoglossal nerve.

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“…The facial nerve 'stripping' technique involves finding a plane between the tumour and the nerve fascicles and dissecting off the tumour from the nerve leaving the nerve intact [77]. This is not always possible and to preserve the nerve a subtotal resection can be attempted.…”

Section: Surgerymentioning

confidence: 99%

Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII)

et al. 2022

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Background Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. Methods A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the second of a three-part series describing non-vestibular schwannomas (V, VII). Results A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies, and follow-up management. Conclusion This article represents the consensually derived opinion of the task force with respect to the treatment of trigeminal and facial schwannoma. The aim of treatment is maximal safe resection with preservation of function. Careful thought is required to select the appropriate surgical approach. Most middle fossa trigeminal schwannoma tumours can be safely accessed by a subtemporal extradural middle fossa approach. The treatment of facial nerve schwannoma remains controversial.

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Stripping surgery in facial nerve schwannomas with favorable facial nerve function

Cited by 8 publications

References 17 publications

Facial Schwannoma Management Outcomes: A Systematic Review of the Literature

Facial Schwannoma Management Outcomes: A Systematic Review of the Literature

Large Intratemporal Facial Nerve Schwannoma without Facial Palsy: Surgical Strategy of Tumor Removal and Functional Reconstruction

Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII)

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