J Korean Neurosurg Soc.  2017 Feb;60(2):165-173. 10.3340/jkns.2013.0407.001.

Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

• Hong W
• Cheng H
• Wang X
• Feng C

• KMID: 2374877
• DOI: http://doi.org/10.3340/jkns.2013.0407.001

Abstract

OBJECTIVE
To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma.
METHODS
Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function.
RESULTS
Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I-II level) cases accounted for 75.2% (79/105), facial nerve function III-IV level cases accounted for 22.9% (24/105), and V-VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I-II level) was 74.4% (58/78).
CONCLUSION
Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient's age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms.

Keyword

Acoustic neuroma; Facial nerve function; Sigmoid sinus approach; Electrophysiological monitoring; Keyhole; Internal acoustic meatus

MeSH Terms

Acoustics*
Colon, Sigmoid
Facial Nerve*
Humans
Hydrocephalus
Microsurgery
Mortality
Neuroanatomy
Neuroma, Acoustic*
Outpatients
Recurrence
Retrospective Studies
Telephone

Reference

References

1. Bartalena T, Leoni C, Trossello MP, Rinaldi MF, Cianfoni A, Caprara G, et al. Hourglass cystic schwannoma of the trochlear nerve. Acta Biomed. 81:147–150. 2010.

2. Charalampaki P, Filippi R, Welschehold S, Perneczky A. Endoscope-assisted removal of colloid cysts of the third ventricle. Neurosurg Rev. 29:72–79. 2006.

3. Chen L, Chen LH, Ling F, Liu YS, Samii M, Samii A. Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy. Chin Med J (Engl). 123:274–280. 2010.

4. Frasson L, Ko SY, Turner A, Parittotokkaporn T, Vincent JF, Rodriguez y Baena F. STING: a soft-tissue intervention and neurosurgical guide to access deep brain lesions through curved trajectories. Proc Inst Mech Eng H. 224:775–788. 2010.

5. Gharabaghi A, Samii A, Koerbel A, Rosahl SK, Tatagiba M, Samii M. Preservation of function in vestibular schwannoma surgery. Neurosurgery. 60(2 Suppl 1):ONS124–ONS127. discussion ONS127–ONS128. 2007.

6. Gjurić M, Wigand ME, Wolf SR. Enlarged middle fossa vestibular schwannoma surgery: experience with 735 cases. Otol Neurotol. 22:223–230. discussion 230–231. 2001.

7. Gurgel RK, Theodosopoulos PV, Jackler RK. Subtotal/near-total treatment of vestibular schwannomas. Curr Opin Otolaryngol Head Neck Surg. 20:380–384. 2012.

8. Han JS, Lee JA, Kong DS, Park K. Delayed cranial nerve palsy after microvascular decompression for hemifacial spasm. J Korean Neurosurg Soc. 52:288–292. 2012.

9. Khu KJ, Ng WH. Intraoperative swelling leading to neurological deterioration: an argument for large craniotomy in awake surgery for glioma resection. Clin Neurosci. 16:886–888. 2009.

10. Kondziolka D, Mousavi SH, Kano H, Flickinger JC, Lunsford LD. The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation? Neurosurg Focus. 33:e8. 2012.

11. Limb CJ, Long DM, Niparko JK. Acoustic neuromas after failed radiation therapy: challenges of surgical salvage. Laryngoscope. 115:93–98. 2005.

12. Mazzoni A, Zanoletti E, Calabrese V. Hearing preservation surgery in acoustic neuroma: long-term results. Acta Otorhinolaryngol Ital. 32:98–102. 2012.

13. Oh T, Nagasawa DT, Fong BM, Trang A, Gopen Q, Parsa AT, et al. Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas. Neurosurg Focus. 33:e6. 2012.

14. Paladino J, Pirker N, Stimac D, Stern-Padovan R. Eyebrow keyhole approach in vascular neurosurgery. Minim Invasive Neurosurg. 41:200–203. 1998.

15. Park HS, Chang DK, Han YM. Infranuchal infrafloccular approach to the more vulnerable segments of the facial nerve in microvascular decompressions for the hemifacial spasm. J Korean Neurosurg Soc. 46:340–345. 2009.

16. Park HS, Park SK, Han YM. Microsurgical experience with supraorbital keyhole operations on anterior circulation aneurysms. J Korean Neurosurg Soc. 46:103–108. 2009.

17. Porter RG, LaRouere MJ, Kartush JM, Bojrab DI, Pieper DR. Improved facial nerve outcomes using an evolving treatment method for large acoustic neuromas. Otol Neurotol. 34:304–310. 2013.

18. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery. 40:11–21. discussion 21–23. 1997.

19. Scheller C, Richter HP, Engelhardt M, KÖenig R, Antoniadis G. The influence of prophylactic vasoactive treatment on cochlear and facial nerve functions after vestibular schwannoma surgery: a prospective and open-label randomized pilot study. Neurosurgery. 61:92–97. discussion 97–98. 2007.

20. Shchekut’ev GA, Shimanskiĭ VN, Ogurtsova AA, Semenov MS. Identification of the cochlear nerve in surgical removal of vestibular schwannomas. Zh Vopr Neirokhir Im N N Burdenko. (3):10–13. discussion 13–14. 2009.

21. Shin D, Park J. Unruptured supraclinoid internal carotid artery aneurysm surgery: superciliary keyhole approach versus pterional approach. J Korean Neurosurg Soc. 52:306–311. 2012.

22. Somers T, Van Havenbergh T. Multidisciplinary management of vestibular schwannomas: state of the art. B-ENT. 8:235–240. 2012.

23. Stadie AT, Reisch R, Kockro RA, Fischer G, Schwandt E, Boor S, et al. Minimally invasive cerebral cavernoma surgery using keyhole approaches - solutions for technique-related limitations. Minim Invasive Neurosurg. 52:9–16. 2009.

24. Strauss C, Romstöck J, Fahlbusch R, Rampp S, Scheller C. Preservation of facial nerve function after postoperative vasoactive treatment in vestibular schwannoma surgery. Neurosurgery. 59:577–584. discussion 577–584. 2006.

25. Sughrue ME, Kaur R, Rutkowski MJ, Kane AJ, Yang I, Pitts LH, et al. A critical evaluation of vestibular schwannoma surgery for patients younger than 40 years of age. Neurosurgery. 67:1646–1653. discussion 1653–1654. 2010.

26. Sun S, Liu A. Long-term follow-up studies of Gamma Knife surgery with a low margin dose for vestibular schwannoma. J Neurosurg. 117(Suppl):57–62. 2012.

27. Yashar P, Zada G, Harris B, Giannotta SL. Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature. Neurosurg Focus. 33:e13. 2012.

28. Yi JS, Lee HJ, Lee HJ, Lee IW, Yang JH. Rat peripheral nerve regeneration using nerve guidance channel by porcine small intestinal submucosa. J Korean Neurosurg Soc. 53:65–71. 2013.

29. Youssef AS, Downes AE. Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications. Neurosurg Focus. 27:e9. 2009.