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Liu J, Fan X, Yang L, Tao X, Jin Y, Li K, Yang J, Qiao H. Predictive value of Blink reflex and facial corticobulbar motor evoked potential in cerebellopontine angle tumor surgery. Clin Neurophysiol 2024; 162:165-173. [PMID: 38642482 DOI: 10.1016/j.clinph.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE The current study examined the efficacy of the facial corticobulbar motor evoked potentials (FCoMEPs) and blink reflex (BR) on predicting postoperative facial nerve function during cerebellopontine angle (CPA) tumor surgery. METHODS Data from 110 patients who underwent CPA tumor resection with intraoperative FCoMEPs and BR monitoring were retrospectively reviewed. The association between the amplitude reduction ratios of FCoMEPs and BR at the end of surgery and postoperative facial nerve function was determined. Subsequently, the optimal threshold of FCoMEPs and BR for predicting postoperative facial nerve dysfunction were determined by receiver operating characteristic curve analysis. RESULTS Valid BR was record in 103 of 110 patients, whereas only 43 patients successfully recorded FCoMEP in orbicularis oculi muscle. A reduction over 50.3% in FCoMEP (O. oris) amplitude was identified as a predictor of postoperative facial nerve dysfunction (sensitivity, 77.1%; specificity, 83.6%). BR was another independent predictor of postoperative facial nerve deficit with excellent predictive performance, especially eyelid closure function. Its optimal cut-off value for predicting long-term postoperative eyelid closure dysfunction was was 51.0% (sensitivity, 94.4%; specificity, 94.4%). CONCLUSIONS BR can compensate for the deficiencies of the FCoMEPs. The combination of BR and FCoMEPs can be used in CPA tumor surgery. SIGNIFICANCE The study first proposed an optimal cut-off value of BR amplitude deterioration (50.0%) for predicting postoperative eyelid closure deficits in patients undergoing CPA tumor surgery.
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Affiliation(s)
- Jiajia Liu
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Xing Fan
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Lirui Yang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Xiaorong Tao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Yanwen Jin
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Ke Li
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Jun Yang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.
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Prado MB, Kubota Y. Utility and Prognostic Value of Intraoperative Blink Reflex in Trigeminal or Facial Nerve Monitoring in Skull Base Surgeries: A Systematic Review. World Neurosurg 2024:S1878-8750(24)00737-X. [PMID: 38705267 DOI: 10.1016/j.wneu.2024.04.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Blink reflex (BR) is an oligosynaptic reflex that involves the ophthalmic branch of the trigeminal nerve (TN), ipsilateral main sensory and trigeminospinal nuclei, bilateral facial nuclei, and the facial nerves (FNs). Theoretically, as BR tests the function of both TN and FNs simultaneously, it is an ideal tool for monitoring the status of TN and FNs during skull base surgeries. Nevertheless, it has been used only recently in surgeries as the use of anesthesia limits its use. METHODS For this systematic review, 2 authors input the search terms [(Blink Reflex) AND (Intraoperative Neuromonitoring OR Neuro Intraoperative Monitoring OR Intraoperative OR NIOM OR IONM) AND (skull base surgery OR Facial Nerve OR Trigeminal Nerve OR Microvascular Decompression OR Hemifacial Spasm)] in MEDLINE through its PubMed interface and other search engines. Articles that fulfilled the inclusion and exclusion criteria were obtained and scrutinized. RESULTS Seven observational articles with a total of 437 participants were included. All 5 studies that described the use of BR in FN surgery noted that intraoperative BR is beneficial, safe, sensitive, specific, and predictive of outcomes, while 2 articles describing patients with trigeminal neuralgia recommended use of BR in microvascular decompression of TN. CONCLUSIONS Intraoperative BR is a sensitive, specific, and safe monitoring technique that has good predictability of facial paresis and paresthesia among patients undergoing MVD for trigeminal neuralgia and primary hemifacial spasm and patients undergoing cerebellopontine angle tumor resection.
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Affiliation(s)
- Mario B Prado
- Department of Neurosurgery, Tokyo Women Medical University - Adachi Medical Center, Tokyo, Japan; Department of Physiology, College of Medicine, University of the Philippines, Manila, Philippines.
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women Medical University - Adachi Medical Center, Tokyo, Japan
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Yoo MC. Diagnostic Value of Preoperative Electrodiagnostic Analysis in a Patient with Facial Palsy and a Large Vestibular Schwannoma: Case Report. Diagnostics (Basel) 2022; 12:diagnostics12020542. [PMID: 35204631 PMCID: PMC8871403 DOI: 10.3390/diagnostics12020542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022] Open
Abstract
Although radiologic methods confirm the diagnosis of patients with large vestibular schwannomas, these methods usually indicate only the size of the tumor and its possible nerve compression. Electrodiagnostic methods can reveal the functional state of the nerves, particularly the trigeminal and facial nerves, as well as providing a basis for objectively evaluating nerve injury. Due to the lack of an established objective evaluation method, electrodiagnostic methods were utilized to assess injury to the cranial nerve in a patient with a large vestibular schwannoma. A 79-year-old woman presented with a one-month history of right facial palsy, vertigo, dizziness, right postauricular pain, and right-sided hearing disturbance. Physical examination suggested injuries to the facial and vestibulocochlear nerves. Magnetic resonance imaging identified a vestibular schwannoma and showed that the tumor mass was affecting the brainstem, including the fourth ventricle, resulting in mild obstructive hydrocephalus. Preoperative electrodiagnostic evaluation identified asymptomatic trigeminal neuropathy accompanying a vestibular schwannoma. The patient underwent surgery, consisting of a suboccipital craniotomy with additional gamma knife radiosurgery. Postoperatively, she demonstrated significant recovery from right facial palsy and partial improvement of her neurologic symptoms. Large vestibular schwannomas with facial paralysis may be accompanied by additional entrapment neuropathy. Routine preoperative electrophysiological evaluation is recommended to establish a definitive diagnosis and evaluate the function of the trigeminal nerve, facial nerve, and brainstem in patients with large and compressive vestibular schwannomas.
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Affiliation(s)
- Myung Chul Yoo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University Hospital, 23 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Korea
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Kiessling PT, Marinelli JP, Peters PA, DeLone DR, Lane JI, Koster MJ, Carlson ML. In Response to "Neurophysiologic Testing Utility in Granulomatosis With Polyangiitis". Otolaryngol Head Neck Surg 2021; 164:454-455. [PMID: 33527872 DOI: 10.1177/0194599820956962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sacchetto L, Fabbris C, Romito S, Bianconi L, Marchioni D. Facial Nerve Neurophysiologic Assessment in Vestibular Schwannoma Removal with Transcanal Approach: A Pilot Clinical Study. World Neurosurg 2020; 146:e568-e574. [PMID: 33189920 DOI: 10.1016/j.wneu.2020.10.139] [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: 08/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The transcanal transpromontorial approach has been introduced to remove vestibular schwannomas. As with other techniques, preservation of the facial nerve (FN) is challenging. This pilot study described FN outcomes of patients preoperatively and postoperatively assessed with electromyography (EMG) and blink reflex (BR). METHODS Between September 2017 and December 2018, 10 patients (5 men; 5 women; mean age, 59.8 years; age range, 25-77 years) underwent removal of vestibular schwannoma via the transcanal transpromontorial approach. FN assessment using EMG/BR and clinical evaluation with the House-Brackmann (HB) grading scale was performed preoperatively and 2 months postoperatively. If facial impairment was present postoperatively, further analysis was performed 6 months after surgery. RESULTS All 10 patients had normal FN function on preoperative EMG/BR. After 2 months, 4 patients had normal FN function on EMG/BR, 4 patients showed a slight delay of FN responses, 1 patient had moderate dysfunction, and 1 patient had consistent damage. After 6 months, among the 6 patients with a pathologic neurophysiologic study, consistent EMG/BR improvement was shown, with complete recovery in 3 cases. At the last follow-up, 8 patients had HB grade I, 1 patient had HB grade II, and 1 patient had HB grade III in 1, showing progression toward healing in 9 of 10 cases. CONCLUSIONS The transcanal transpromontorial approach is an effective procedure for vestibular schwannoma removal. EMG/BR represents an objective evaluation method to verify FN recovery after surgery and confirms the low impact of this surgical procedure on the FN.
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Affiliation(s)
- Luca Sacchetto
- Otolaryngology, University Hospital of Verona, Verona, Italy
| | | | - Silvia Romito
- Neurology Departments, University Hospital of Verona, Verona, Italy
| | - Luca Bianconi
- Otolaryngology, University Hospital of Verona, Verona, Italy
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Predictive Value of Preoperative and Intraoperative Neurophysiology in Evaluating Long-term Facial Function Outcome in Acoustic Neuroma Surgery. Otol Neurotol 2020; 41:530-536. [DOI: 10.1097/mao.0000000000002553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kunert P, Podgórska A, Dziedzic TA, Marchel A. Utility of preoperative electrophysiological testing of the facial nerve in patients with vestibular schwannoma. PLoS One 2019; 14:e0226607. [PMID: 31869358 PMCID: PMC6927592 DOI: 10.1371/journal.pone.0226607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to analyze the utility of various preoperative electrophysiological tests of the facial nerve CNVII in predicting CNVII function after vestibular schwannoma surgery. Methods This retrospective study included 176 patients who had preoperative facial nerve electroneurography and electrically evoked blink reflex testing. We defined the following variables: axonal degeneration of CNVII (AD-CNVII), trigeminal nerve damage (D-CNV), disturbances in the short-latency pathway of the blink reflex (D-BR), and any changes in electrophysiological test results (A-EMG). Results AD-CNVII, D-CNV, D-BR, and A-EMG were noted in 24%, 10%, 64%, and 71% of the patients, respectively. Negative D-CNV correlated with good CNVII function in early (p = 0.005) and long-term follow-up (p = 0.003) but was not an independent prognostic factor for postoperative facial muscles function. D-CNV appeared to be closely related to tumor size. D-BR was related to tumor size and had no predictive value. AD-CNVII (amplitude reduction of 50% or more compared to the healthy side) was an independent factor associated with increased risk of facial muscles weakness (p = 0.015 and p = 0.031 for early and late outcomes, respectively). Conclusions Further studies are needed to establish which tests and cut-off values are the most useful for predicting post-surgical facial nerve function.
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Affiliation(s)
- Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
- * E-mail:
| | - Anna Podgórska
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Blink test results in patients with central sleep apnea syndrome. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mancini P, De Seta D, Prosperini L, Nicastri M, Gabriele M, Ceccanti M, Sementilli G, Terella M, Bertoli GA, Filipo R, Inghilleri M. Prognostic factors of Bell's palsy: Multivariate analysis of electrophysiological findings. Laryngoscope 2014; 124:2598-605. [DOI: 10.1002/lary.24764] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Luca Prosperini
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | - Maria Nicastri
- Department of Sense Organs; University Sapienza; Rome Italy
| | - Maria Gabriele
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | | | - Maria Terella
- Department of Sense Organs; University Sapienza; Rome Italy
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Facial nerve dysfunction after drainage of cerebrospinal fluid during vestibular schwannoma surgery. Clin Neurol Neurosurg 2013; 115:102-5. [DOI: 10.1016/j.clineuro.2012.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 04/01/2012] [Accepted: 04/02/2012] [Indexed: 11/24/2022]
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Prell J, Rachinger J, Scheller C, Alfieri A, Strauss C, Rampp S. A Real-Time Monitoring System for the Facial Nerve. Neurosurgery 2010; 66:1064-73; discussion 1073. [DOI: 10.1227/01.neu.0000369605.79765.3e] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Damage to the facial nerve during surgery in the cerebellopontine angle is indicated by A-trains, a specific electromyogram pattern. These A-trains can be quantified by the parameter “traintime,” which is reliably correlated with postoperative functional outcome. The system presented was designed to monitor traintime in real-time.
METHODS
A dedicated hardware and software platform for automated continuous analysis of the intraoperative facial nerve electromyogram was specifically designed. The automatic detection of A-trains is performed by a software algorithm for real-time analysis of nonstationary biosignals. The system was evaluated in a series of 30 patients operated on for vestibular schwannoma.
RESULTS
A-trains can be detected and measured automatically by the described method for real-time analysis. Traintime is monitored continuously via a graphic display and is shown as an absolute numeric value during the operation. It is an expression of overall, cumulated length of A-trains in a given channel; a high correlation between traintime as measured by real-time analysis and functional outcome immediately after the operation (Spearman correlation coefficient [ρ] = 0.664, P < .001) and in long-term outcome (ρ = 0.631, P < .001) was observed.
CONCLUSION
Automated real-time analysis of the intraoperative facial nerve electromyogram is the first technique capable of reliable continuous real-time monitoring. It can critically contribute to the estimation of functional outcome during the course of the operative procedure.
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Affiliation(s)
- Julian Prell
- Department of Neurosurgery, University of Halle, Halle, Germany
| | - Jens Rachinger
- Department of Neurosurgery, University of Halle, Halle, Germany
| | | | - Alex Alfieri
- Department of Neurosurgery, University of Halle, Halle, Germany
| | | | - Stefan Rampp
- Department of Neurosurgery, University of Halle, Halle, Germany
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Yingling CD, Gardi JN. Intraoperative Monitoring of Facial and Cochlear Nerves During Acoustic Neuroma Surgery. Neurosurg Clin N Am 2008; 19:289-315, vii. [DOI: 10.1016/j.nec.2008.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Prell J, Rampp S, Romstöck J, Fahlbusch R, Strauss C. Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma. J Neurosurg 2007; 106:826-32. [PMID: 17542526 DOI: 10.3171/jns.2007.106.5.826] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors describe a quantitative electromyographic (EMG) parameter for intraoperative monitoring of facial nerve function during vestibular schwannoma removal. This parameter is based on the automated detection of A trains, an EMG pattern that is known to be associated with postoperative facial nerve paresis.
Methods
For this study, 40 patients were examined. During the entire operative procedure, free-running EMG signals were recorded in muscles targeted by the facial nerve. A software program specifically designed for this purpose was used to analyze these continuous recordings offline. By automatically adding up time intervals during which A trains occurred, a quantitative parameter was calculated, which was named “train time.”
A strong correlation between the length of train time (measured in seconds) and deterioration of postoperative facial nerve function was demonstrated. Certain consecutive safety thresholds at 0.5 and 10 seconds were defined. Their transgression reliably indicated postoperative facial nerve paresis. At less than a 10-second train time, discrete worsening, and at more than 10 seconds, profound deterioration of facial nerve function can be anticipated.
Conclusions
Train time as a quantitative parameter was shown to be a reliable indicator of facial nerve paresis after surgery for vestibular schwannoma.
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Affiliation(s)
- Julian Prell
- Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany.
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Kaylie DM, Jackson CG, Aulino JM, Gardner EK, Weissman JL. Preoperative Appearance of Facial Muscles on Magnetic Resonance Predicts Final Facial Function After Acoustic Neuroma Surgery. Otol Neurotol 2004; 25:622-6. [PMID: 15241245 DOI: 10.1097/00129492-200407000-00034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several previous studies have shown that muscle appearance on magnetic resonance is a sensitive indicator of muscle denervation. Previous attempts at determining preoperative indicators of final facial function after acoustic neuroma removal has been mostly unsuccessful. The goal of this study was to determine if the appearance of the facial muscles on preoperative imaging is predictive of final facial function after surgical removal of vestibular schwannomas. STUDY DESIGN We conducted a retrospective chart and magnetic resonance review. SETTING This study was conducted at a tertiary referral center. PATIENTS We included all patients who underwent vestibular schwannoma removal between January 1, 1997, and December 31, 2001, with available preoperative magnetic resonance images and a minimum of 12 months follow up. INTERVENTIONS We used translabyrinthine, middle fossa, and suboccipital approaches for tumor removal. A neuroradiologist, blinded to preoperative or final facial function after tumor removal, retrospectively reviewed preoperative magnetic resonance images. MAIN OUTCOMES MEASURES Facial muscles were evaluated on magnetic resonance and classified as symmetric or asymmetric. Facial function was graded using the House-Brackmann scale. Preoperative facial function was noted on the preoperative physical examination. Final function was determined at least 12 months postoperatively. RESULTS A total of 247 patients underwent tumor removal during the study period. One hundred thirty-two patients had adequate preoperative magnetic resonance images. Patients with preoperative facial muscle asymmetry seen on preoperative magnetic resonance indicating muscle atrophy had significantly worse final facial function, regardless of tumor size. CONCLUSION The preoperative appearance of facial muscles provides valuable insight into the physiology of the facial nerve in the presence of vestibular schwannomas. Patients with pre-operative facial muscle symmetry have significantly better facial function than those with atrophy.
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Darrouzet V, Martel J, Enée V, Bébéar JP, Guérin J. Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope 2004; 114:681-8. [PMID: 15064624 DOI: 10.1097/00005537-200404000-00016] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of the study was to evaluate the incidence of short- and intermediate-term postoperative complications after vestibular schwannoma surgery. STUDY DESIGN Retrospective review in a tertiary referral center. METHODS In 400 patients who underwent surgical removal of vestibular schwannoma from 1984 to 2000,symptoms, preoperative evaluation, surgery, and postoperative complications were analyzed using standardized grading systems. RESULTS One hundred ninety-four men and 206 women had an operation. Mean age was 53.9 years (age range, 11-78 y). Tumor size according to Koos stage was stage 1 in 39 cases, stage 2 in 122 cases, stage 3 in 87 cases, and stage 4 in 152 cases. Preoperatively, 7.5% of patients had facial nerve dysfunction. Surgical approaches were translabyrinthine in 229 patients, widened retrolabyrinthine in 128 cases, suboccipital in 42 cases, and transotic in 1 case. Mortality was 0.5%. Facial nerve was transected in 15 cases (3.7%) and immediately repaired in 5 cases. A delayed hypoglossal-to-facial nerve anastomosis was performed in 12 cases. At 1 year, House-Brackmann grade in 70.7% of patients was 1 to 2; in 24.3%, 3 to 4; and in 5%, 5 to 6. Poor facial nerve outcome was correlated with tumor size, preoperative irradiation, and nerve dysfunction and was not correlated with the approach used. Most patients had postoperative dizziness, and 30% still had vestibular disturbances after 1 year. Nine patients (2.2%) had a cerebrospinal fluid rhinorrhea, and 24 had a cerebrospinal fluid wound leak (6%). Twenty-two patients (5.5%) had postoperative meningitis. Two patients had a cerebellopontine angle hemorrhage, and three a brainstem infarct. CONCLUSION Transpetrosal approaches (translabyrinthine, widened retrolabyrinthine) are safe for vestibular schwannoma removal, and rates of postoperative complications and sequelae are decreasing.
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Affiliation(s)
- Vincent Darrouzet
- Department of Skull Base Surgery, University Hospital of Bordeaux, Bordeaux, France.
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