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Erbele ID, Klumpp ML, Arriaga MA. Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment. Laryngoscope 2021; 131:2098-2105. [PMID: 34013983 DOI: 10.1002/lary.29628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Assesses whether preoperative functional testing can distinguish vestibular schwannomas from facial nerve schwannomas medial to the labyrinthine segment. STUDY DESIGN Retrospective cohort. METHODS Retrospectively review surgically managed intracranial facial and vestibular schwannomas between January 2015 and December 2019 at two tertiary care centers. Patients with neurofibromatosis 2 and surgery for recurrence were excluded. Preoperative functional testing to include House-Brackmann scores, electroneuronography (ENoG), cervical vestibular evoked myogenic potentials (cVEMP), caloric testing, acoustic brainstem responses (ABRs), acoustic reflexes, and audiograms was compared between the two groups of schwannomas. RESULTS Twelve facial and 128 vestibular schwannomas met inclusion criteria. In only one case was a facial schwannoma diagnosed preoperatively from imaging. No statistically significant difference was found in preoperative House-Brackmann scores, ENoG, cVEMP, caloric testing, ABRs, or acoustic reflexes. Pure tone average was worse in the vestibular schwannoma group (63 dB [95% CI: 58-68 dB] vs. 46 dB [95% CI: 34-58 dB], P = .01), and the difference was more apparent in the lower frequencies. Word recognition score was better in the facial schwannoma group (66% [95% CI: 45-86%] vs. 41% [95% CI: 34-47%], P = .02). CONCLUSION Specialized preoperative functional evaluation of the nerves of the internal auditory canal cannot reliably predict the presence of an intracranial facial schwannoma. Hearing is better in facial schwannomas, particularly in the lower frequencies. This should raise the index of suspicion for an intracranial facial schwannoma, especially in candidates for hearing preservation vestibular schwannoma surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2098-2105, 2021.
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Affiliation(s)
- Isaac D Erbele
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, Baton Rouge and New Orleans, Louisiana, U.S.A.,Hearing and Balance Center, Our Lady of the Lady Regional Medical Center, Baton Rouge, Louisiana, U.S.A.,Department of Otolaryngology, Brooke Army Medical Center, Fort Sam Houston, Texas, U.S.A.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Micah L Klumpp
- Hearing and Balance Center, Our Lady of the Lady Regional Medical Center, Baton Rouge, Louisiana, U.S.A
| | - Moisés A Arriaga
- Department of Otolaryngology, Division of Neurotology, Louisiana State University Health Sciences Center, Baton Rouge and New Orleans, Louisiana, U.S.A.,Hearing and Balance Center, Our Lady of the Lady Regional Medical Center, Baton Rouge, Louisiana, U.S.A
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Furukawa T, Fabbris C, Ito T, Hiraka T, Goto T, Kubota T, Matsui H, Ohe R, Kanoto M, Kakehata S. Facial nerve and chorda tympani schwannomas: Case series, and advantages of using non-rigid registration of post-enhanced 3D-T1 Turbo Field Echo and CT images (TURFECT) in their diagnosis and surgical treatment. Auris Nasus Larynx 2020; 47:383-390. [DOI: 10.1016/j.anl.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
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Evaluation of Semicircular Canal Function by Video Head Impulse Test in Patients With Facial Nerve Schwannoma. Otol Neurotol 2020; 41:e615-e622. [DOI: 10.1097/mao.0000000000002591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kang WS, Han JJ, Rhee J, Lee JH, Koo JW, Chung JW. Surgical Outcomes of Intratemporal Facial Nerve Schwannomas According to Facial Nerve Manipulation. J Int Adv Otol 2019; 15:415-419. [PMID: 31846922 DOI: 10.5152/iao.2019.7189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the preoperative and postoperative facial nerve (FN) function in patients with FN schwannoma (FNS) and analyze the duration of preoperative facial palsy according to the preoperative and postoperative facial function. MATERIALS AND METHODS We retrospectively reviewed the medical records of 29 patients with FNS who underwent surgery. We evaluated the FN function according to the type of FN manipulation and location of the anastomoses in the cable nerve graft, and we also analyzed the duration of facial palsy according to the facial function before and after surgery. RESULTS All 4 patients who underwent nerve-stripping surgery had the House-Brackmann (H-B) Grade III, 12 of 21 who underwent a cable nerve graft had the H-B Grade III or better postoperatively, and all 4 who underwent a hypoglossal facial crossover had the H-B Grade IV. Patients who underwent cable nerve grafting were more likely to have better FN function when the proximal anastomosis site was located in the internal auditory canal, geniculate ganglion, tympanic segment of FN, and distal end in the mastoid segment of FN. The duration of preoperative facial palsy was statistically shorter in patients with better postoperative facial function. CONCLUSION Surgery can be considered in patients with FNS who have the H-B Grade III or worse. A shorter duration of facial palsy prior to surgery resulted in better postoperative facial function.
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Affiliation(s)
- Woo Seok Kang
- Department of Otorhinolaryngology-Head - Neck Surgery, Asan Medical Center, Seoul, Korea, Republic Of
| | - Jae Joon Han
- Department of Otorhinolaryngology-Head - Neck Surgery, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Korea, Republic Of
| | - Jihye Rhee
- Department of Otorhinolaryngology, Veterans Health Service Medical Center, Seoul, Korea, Republic Of
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head - Neck Surgery, Seoul National University Hospital, Seoul, Korea, Republic Of
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head - Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Republic Of
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head - Neck Surgery, Asan Medical Center, Seoul, Korea, Republic Of
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Eshraghi AA, Oker N, Ocak E, Verillaud B, Babcock T, Camous D, Kravietz A, Morcos J, Herman P, Kania R. Management of Facial Nerve Schwannoma: A Multicenter Study of 50 Cases. J Neurol Surg B Skull Base 2018; 80:352-356. [PMID: 31316881 DOI: 10.1055/s-0038-1670687] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/08/2018] [Indexed: 01/08/2023] Open
Abstract
Objective In the management of facial nerve schwannoma (FNS), surgical tumor resection is now often being replaced with more conservative approaches, such as observation with serial imaging or stereotactic radiosurgery (SRS). Given the scarcity of these lesions, determining the optimal management of FNS remains challenging and subject of debate with multiple treatment approaches supported in the literature. Methods A retrospective chart review was performed in two academic centers for patients diagnosed with FNS between 1996 and 2017. The clinical presentation, treatment modalities employed, tumor control rates, and facial nerve function (FNF) outcomes (House-Brackmann system) were assessed and analyzed. Results The study comprised 50 adult patients. Initial treatment modalities included observation with serial clinicoradiologic review in 27 patients (54%), surgery in 17 patients (34%), and SRS in 6 patients (12%). The FNF were decreased in more than half of the patients who had surgery. Nonetheless, more than 80% of the patients who were initially managed with observation or SRS had stable or improved FNF. Conclusion A prevailing trend toward more conservative treatment modalities for FNS has evolved over time, providing relatively long-term preservation of FNF. As there are multiple management options available, it is of paramount importance that the treating physician be familiar with all treatment modalities and outcomes and counsel patients appropriately. The surgery should be reserved for large tumors and poor FNF at initial presentation or follow-up while watchful observation with imaging is the treatment of choice for rest of the patients.
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Affiliation(s)
- Adrien A Eshraghi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, United States
| | - Natalie Oker
- Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
| | - Emre Ocak
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States
| | - Benjamin Verillaud
- Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
| | - Thomas Babcock
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States
| | - Domitille Camous
- Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
| | - Adam Kravietz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States
| | - Jacques Morcos
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, United States
| | - Philippe Herman
- Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
| | - Romain Kania
- Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
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Aboukais R, Bonne NX, Baroncini M, Zairi F, Schapira S, Vincent C, Lejeune JP. Management of multiple tumors in neurofibromatosis type 2 patients. Neurochirurgie 2015; 64:364-369. [PMID: 26071178 DOI: 10.1016/j.neuchi.2014.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/15/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neurofibromatosis type 2 is characterized by the presence of bilateral vestibular schwannomas. However, other nervous system tumors may also occur. Therefore, the management of NF2 patients is complex and requires a multidisciplinary discussion in a specialized center. MATERIALS AND METHODS All recent articles concerning tumors other than vestibular schwannoma in NF2 disease were reviewed, using PubMed databases. RESULTS Intracranial meningiomas occur in 50% of NF2 patients, and are often multiple. Surgery remains the main treatment and should be performed in cases of growing tumors. The role of antiangiogenic therapy is currently under evaluation and the role of radiosurgery still remains to be defined in NF2 disease. Spinal tumors occur in about half of NF2 patients. Surgery should be discussed when radiological tumor progression is demonstrated, even if spinal tumors are asymptomatic, in order to preserve neurological function and good quality of life. As regards lower cranial nerve schwannomas, radiosurgery appears to be a more appropriate treatment for growing tumor with a small volume in order to avoid post-operative complications, especially swallowing disorders. Facial nerve schwannomas may appear, on MRI, like vestibular schwannomas. The diagnosis should be suspected when the facial palsy is an early symptom during cerebello-pontine tumor progression. Trigeminal schwannomas are frequent in NF2 disease and fortunately they are often asymptomatic. Among major neurofibromatosis types, peripheral nerve sheath schwannomas are only present in patients with NF2 disease and schwannomatosis. Surgical resection is required when the cutaneous schwannomas is painful or when tumor progression is observed and causes symptoms. CONCLUSION Tumors other than vestibular schwannoma are also associated with a poor prognosis in NF2 patients. Surgery remains the main treatment in most cases. Each treatment decision in NF2 disease requires a complete evaluation of all cranial and spinal locations of the disease in order to establish surgical priorities and strategies.
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Affiliation(s)
- R Aboukais
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France.
| | - N-X Bonne
- Department of Otology and Neurotology, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - M Baroncini
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - F Zairi
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - S Schapira
- Department of Otology and Neurotology, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - C Vincent
- Department of Otology and Neurotology, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
| | - J-P Lejeune
- Department of Neurosurgery, Lille University Hospital, rue E.-Lainé, 59037 Lille cedex, France
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Surgical findings to differentiate between facial nerve schwannoma and vestibular schwannoma. Clin Exp Otorhinolaryngol 2014; 7:157-9. [PMID: 25177428 PMCID: PMC4135148 DOI: 10.3342/ceo.2014.7.3.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 12/03/2022] Open
Abstract
Objectives Facial nerve schwannomas may be misdiagnosed as vestibular schwannomas (VSs) if the tumor is confined to the internal auditory canal (IAC) without involvement the geniculated ganglion or labyrinthine segment of facial nerve. Because facial nerve schwannomas may be misdiagnosed as VSs, we investigated the differences between the two. Methods The study included 187 patients with a preoperative diagnosis of VS. Of these, six were diagnosed with facial nerve schwannomas during surgery. We reviewed the preoperative evaluations and surgical findings of facial nerve schwannomas mimicking VSs. Results No useful preoperative predictors are available for facial nerve schwannomas mimicking VSs. Facial nerve schwannomas are usually confined to the IAC. After opening the dura of the IAC, a facial nerve schwannoma can be diagnosed after identifying a normal-appearing nerve located lateral to the tumor. When this was the case, we performed facial nerve preservation surgery or decompression. Conclusion Facial nerve schwannomas can be differentiated from VSs by identifying specific findings during surgery.
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Burmeister HP, Baltzer PA, Dietzel M, Krumbein I, Bitter T, Schrott-Fischer A, Guntinas-Lichius O, Kaiser WA. Identification of the nervus intermedius using 3T MR imaging. AJNR Am J Neuroradiol 2011; 32:460-4. [PMID: 21292799 DOI: 10.3174/ajnr.a2338] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Improved MR imaging at higher field strengths enables more detailed imaging of cranial nerves. The aim of this study was to assess the identifiability of the NI in the CPA and IAC by using high-resolution 3T MR imaging. MATERIALS AND METHODS Twenty-seven healthy volunteers (13 men and 14 women; mean age, 33 years) underwent 3T MR imaging of the CPA. The section thicknesses of the CISS sequence was 0.4 mm (TR, 12.18 ms; TE, 6.09 ms) using a 12-channel head coil. Evaluation was performed by using MPR mode. Image quality and identifiability of the NI were rated independently by 2 observers according to predefined criteria on an ordinal scale. Interobserver agreement was assessed by κ statistics. RESULTS Fifty-four NIs were evaluated. Both observers were able to identify the NI in nearly 60% of cases. It was possible to indentify at least 1 NI in 70% of all volunteers in the CPA and/or IAC. Image quality ratings showed a substantial agreement (κ = 0.65) and identifiability ratings an almost perfect (κ = 0.83) agreement. CONCLUSIONS Careful evaluation of all nervous and vascular structures in the CPA and IAC at high-resolution 3T MR imaging allows reliable depiction of the NI.
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Affiliation(s)
- H P Burmeister
- Institute of Diagnostic and Interventional Radiology, University Hospital, Friedrich Schiller University, Jena, Germany.
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Thompson AL, Aviv RI, Chen JM, Nedzelski JM, Yuen HW, Fox AJ, Bharatha A, Bartlett ES, Symons SP. Magnetic resonance imaging of facial nerve schwannoma. Laryngoscope 2009; 119:2428-36. [DOI: 10.1002/lary.20644] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kim J, Moon IS, Lee JD, Shim DB, Lee WS. Useful surgical techniques for facial nerve preservation in tumorous intra-temporal lesions. Auris Nasus Larynx 2009; 37:33-41. [PMID: 19447573 DOI: 10.1016/j.anl.2009.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 04/01/2009] [Accepted: 04/04/2009] [Indexed: 11/17/2022]
Abstract
The management of the facial nerve in tumorous temporal lesions is particularly challenging due to its complex anatomic location and potential postoperative complications, including permanent facial paralysis. The most important concern regarding surgical treatment of a tumorous temporal lesion is the inevitable facial paralysis caused by nerve injury during the tumor removal, especially in patients with minimal to no preoperative facial nerve dysfunction. We describe successful four cases in which various surgical techniques were developed for the preservation of the facial nerve in treatment of intratemporal tumorous lesions.
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Affiliation(s)
- Jin Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Republic of Korea
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Lee JD, Kim SH, Song MH, Lee HK, Lee WS. Management of Facial Nerve Schwannoma in Patients With Favorable Facial Function. Laryngoscope 2009; 117:1063-8. [PMID: 17464236 DOI: 10.1097/mlg.0b013e31804b1a51] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We report six cases of facial nerve schwannomas in which surgical management allowed the preservation of facial nerve function. Specifically, this paper reports that a stripping surgery may provide favorable functional outcomes. STUDY DESIGN A retrospective review of preoperative and postoperative data for six patients with facial nerve schwannoma that had normal facial nerve function or a House-Brackmann grade II facial palsy before the surgery. METHODS Stripping surgery, which removed the schwannoma from the remaining nerve fascicle, was attempted on the six patients. Postoperative facial nerve function and imaging (magnetic resonance imaging) were evaluated. RESULTS Stripping surgery with gross total tumor removal of the mass was performed in four cases. In the two remaining cases, the stripping surgery was not possible, and decompression alone was performed. Favorable preservation of facial function was achieved in all six cases. CONCLUSION It was possible to preserve facial function after surgery to remove facial nerve schwannoma. We suggest that stripping surgery, focused on the preservation of continuity of the facial nerve, may be attempted for facial nerve schwannoma in which favorable facial function has been preserved.
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Affiliation(s)
- Jong Dae Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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