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Accuracy and outcomes of diffusion tensor imaging tractography in resection for vestibular schwannoma for facial nerve preservation. J Neurol Sci 2021; 430:120006. [PMID: 34601356 DOI: 10.1016/j.jns.2021.120006] [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: 01/13/2020] [Revised: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Impairment of facial nerve (FN) function is a common postoperative complication in surgical resections of Vestibular Schwannomas (VS). Diffusion tensor imaging (DTI) tractography creates in vivo imaging of the anatomical location of white matter tracts that can be preoperatively used to visualize the displaced FN. We present an analysis of patients who underwent DTI tractography imaging prior to VS resection. METHODS Patient charts were reviewed from March 2012 to April 2015 who underwent DTI tractography prior to surgical resection for VS. Reliability of this measure was compared to the intraoperative FN location as determined by the surgeon. House Brackmann (HB) score was used to assess facial nerve function. RESULTS A total of 11 patients were included with a mean age of 43 years (range: 19-64) and mean follow-up length of 11.9 months (range: 3.1-34.2). The average maximum tumor diameter was 2.82 cm (range: 1.7-4.2). DTI tractography was accurate in 90.9% (10/11) of patients. Postoperatively, 72.7% (8/11) had a HB score of I or II, 18.2% (2/11) had a HB score of III, and 9.1% (1/11) had a HB score of IV. CONCLUSIONS Facial nerve visualization for VS resection can be accurately visualized using DTI tractography. This modality may lead to reduction of postoperative FN damage.
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Ung N, Mathur M, Chung LK, Cremer N, Pelargos P, Frew A, Thill K, Mathur I, Voth B, Lim M, Yang I. A Systematic Analysis of the Reliability of Diffusion Tensor Imaging Tractography for Facial Nerve Imaging in Patients with Vestibular Schwannoma. J Neurol Surg B Skull Base 2016; 77:314-8. [PMID: 27441156 DOI: 10.1055/s-0035-1566303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022] Open
Abstract
Surgeons need to visualize the facial nerve reliably in relation to the vestibular schwannoma (VS) in surgical planning. Diffusion tensor imaging (DTI) tractography has enabled unprecedented in vivo preoperative visualization. We collected data to measure the accuracy of DTI for an accurate location of the nerve in preoperative VS resection planning. A PubMed search for relevant studies was conducted. Inclusion criteria were gross total resection of VS, preoperative DTI identification of the facial nerve, and intraoperative cranial nerve localization by the surgeon. Exclusion criteria were tumors other than VS and unsuccessful preoperative location of the cranial nerve. Accuracy rate was calculated by comparing the intraoperative and preoperative locations detailed by DTI. The query identified 38 cases of VS that fit our inclusion criteria. Overall, 89% had surgical findings that agreed with the DTI location of the facial nerve. Of these cases, 32 patients had a postoperative House-Brackmann grade I or II. Our findings suggest that DTI is a reliable method for facial nerve imaging. Implementation of this technique may help decrease facial nerve injury during surgery. Limitations and further studies are needed to better understand what factors correlate with successful location of the facial nerve and DTI in patients with VS.
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Affiliation(s)
- Nolan Ung
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Monica Mathur
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Nicole Cremer
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Panayiotis Pelargos
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Andrew Frew
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Kimberly Thill
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Ishani Mathur
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Brittany Voth
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
| | - Michael Lim
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, United States
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Pardo-Maza A, Lassaletta L, González-Otero T, Roda JM, Moraleda S, Arbizu Á, Gavilán J. Evolution of Patients With Immediate Complete Facial Paralysis Secondary to Acoustic Neuroma Surgery. Ann Otol Rhinol Laryngol 2015; 125:495-500. [PMID: 26719351 DOI: 10.1177/0003489415624700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the evolution of patients with immediate complete facial paralysis after acoustic neuroma surgery in different scenarios and assess different facial reanimations techniques. METHODS This study included 50 patients with complete facial paralysis immediately after acoustic neuroma surgery. Data were analyzed into 4 groups according to the need and type of reconstruction of the facial nerve, either none, immediate, or on a deferred basis. All patients had intraoperative facial nerve monitoring, and facial nerve function was evaluated according the House-Brackmann (HB) scale. RESULTS Of all patients with immediate total paralysis, no patients achieved totally normal facial function (grade I), and only 5 (10%) recovered to a grade II. For all groups included, the majority of patients (82%) achieved an acceptable final facial function (grade III HB). In this series, only 2 patients remained with a grade VI facial function. CONCLUSIONS The possibility of recovering near normal facial function after a grade VI facial paralysis is very low. Procedures like the immediate repair of the facial nerve with an interposed donor graft may provide better facial function in patients with partially injured facial nerve. Even in cases of total section, there are other procedures that can improve the results.
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Affiliation(s)
- Adriana Pardo-Maza
- Department of Otolaryngology, La Paz University Hospital, IdiPaz Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, IdiPaz Research Institute, Madrid, Spain
| | - Teresa González-Otero
- Department of Maxillofacial Surgery, La Paz University Hospital, IdiPaz Research Institute, Madrid, Spain
| | - José María Roda
- Department of Neurosurgery, La Paz University Hospital, IdiPaz Research Institute, Madrid, Spain
| | - Susana Moraleda
- Department of Phisical Therapy, La Paz University Hospital, IdiPaz Research Institute, Madrid, Spain
| | - Álvaro Arbizu
- Department of Ophthalmology, Facial Paralysis Unit, La Paz University Hospital, IdiPaz Research Institute, Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, IdiPaz Research Institute, Madrid, Spain
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Facial nerve preservation with preoperative identification and intraoperative monitoring in large vestibular schwannoma surgery. Acta Neurochir (Wien) 2013; 155:1857-62. [PMID: 23877233 DOI: 10.1007/s00701-013-1815-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Microsurgery is an option of choice for large vestibular schwannomas (VSs). Anatomical and functional preservation of facial nerve (FN) is still a challenge in these surgeries. FNs are often displaced and morphologically changed by large VSs. Preoperative identification of FN with magnetic resonance (MR) diffusion tensor tracking (DTT) and intraoperative identification with facial electromyography (EMG) may be desirable for improving functional results of FN. METHOD In this retrospective study, eight consecutive cases with large VS (≥30 mm in maximal extrameatal diameter) were retrospectively studied. FN DTT was performed in each case preoperatively. All the cases underwent microsurgical resection of the tumor with intraoperative FN EMG monitoring. Correctness of prediction for FN location by DTT was verified by the surgeon's inspection. Postoperative FN function of each patient was followed up. RESULTS Preoperative identification of FN was possible in 7 of 8 (87.5 %) cases. FN location predicted by preoperative DTT agreed to surgical finding in all the 7 cases. FN EMG was helpful to locate and protect the FN. Total resection was achieved in 7 of 8 (87.5 %). All FNs were anatomically preserved. All cases had excellent facial nerve function (House-Brackmann Grade I-II). CONCLUSIONS FN DTT is a powerful technique in preoperatively identification of FN in large VS cases. Continuous intraoperative FN EMG monitoring is contributive to locating and protecting FNs. Radical resection of large VSs as well as favorable postoperative FN outcome is available with application of these techniques.
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Scheller K, Scheller C. Nimodipine promotes regeneration of peripheral facial nerve function after traumatic injury following maxillofacial surgery: An off label pilot-study. J Craniomaxillofac Surg 2012; 40:427-34. [DOI: 10.1016/j.jcms.2011.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 07/26/2011] [Accepted: 07/30/2011] [Indexed: 11/28/2022] Open
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Falcioni M, Fois P, Taibah A, Sanna M. Facial nerve function after vestibular schwannoma surgery. J Neurosurg 2011; 115:820-6. [PMID: 21682562 DOI: 10.3171/2011.5.jns101597] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The object of this study was to evaluate long-term postoperative facial nerve (FN) function in patients undergoing vestibular schwannoma (VS) surgery. METHODS The authors retrospectively reviewed the clinical course of patients affected by isolated VSs with normal preoperative FN function, with no previous surgical or radiotherapeutic treatment, and who underwent surgery between 1987 and 2007. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) scale. The minimum postoperative follow-up was 12 months. RESULTS Among the 1550 patients surgically treated at the authors' center, 1151 matched inclusion criteria for the present study. The FN was anatomically interrupted in 48 cases (4.2%), and 51 patients (4.4%) underwent subtotal tumor removal and were considered separately. Among the 1052 patients with anatomically preserved FNs and total tumor removal, 684 (65%) enjoyed postoperative HB Grade I or II and 309 (29.4%) enjoyed Grade III, with the remaining 59 cases (5.6%) suffering unsatisfactory results (HB Grades IV-VI). As expected, FN function results deteriorated in cases of larger tumors. CONCLUSIONS The main factor influencing postoperative FN function was tumor size. Although there was a progressive deterioration in FN function outcome in relation to tumor size, a cutoff point between satisfactory and unsatisfactory results could be identified at around 2 cm in maximum extrameatal tumor diameter, with the "optimal size" for surgery identified at < 1 cm. This finding emphasizes the importance of an early diagnosis and should be kept in mind when selecting the correct timing for VS removal. For small lesions, the results following a middle cranial fossa approach were significantly worse as compared with those following the translabyrinthine and retrosigmoidretrolabyrinthine approaches.
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Coca Pelaz A, Fernández Lisa C, Ramón Gómez J, Pablo Rodrigo J, Luis Llorente J, Suárez C. Parálisis facial completa tras cirugía de neurinoma del acústico: evolución y complicaciones oftalmológicas asociadas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73299-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Coca Pelaz A, Fernández Lisa C, Ramón Gómez J, Pablo Rodrigo J, Luis Llorente J, Suárez C. Complete Facial Palsy Following Surgery for Acoustic Nerve Neurinoma: Evolution and Associated Ophthalmological Complications. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70227-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Taoka T, Hirabayashi H, Nakagawa H, Sakamoto M, Myochin K, Hirohashi S, Iwasaki S, Sakaki T, Kichikawa K. Displacement of the facial nerve course by vestibular schwannoma: Preoperative visualization using diffusion tensor tractography. J Magn Reson Imaging 2006; 24:1005-10. [PMID: 17031835 DOI: 10.1002/jmri.20725] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To preoperatively visualize the course of the facial nerve, which is displaced by vestibular schwannoma, using diffusion tensor (DT) tractography, and to evaluate the agreement with surgical findings. MATERIALS AND METHODS The subjects were eight patients with vestibular schwannoma who had undergone removal surgery. DT MR images were obtained and tracts that were considered to represent the facial nerve were constructed. We assessed the success rate for tract construction and evaluated the agreement between tractography findings and surgery. RESULTS We obtained a tract that connected the internal auditory meatus and brainstem, and was considered to represent the facial nerve in seven of eight cases. The course of the constructed tract agreed with surgical findings in five of these seven cases. One exception was a case in which the tumor was too large to enable intraoperative observation of the facial nerve; however, the facial nerve appeared to be displaced anteriorly at intracapsular resection, in agreement with tractography. In the other case, the schwannoma was mostly cystic. CONCLUSION Tractographs constructed using MR tensor images enabled us to identify tracts considered to represent facial nerves. We consider DT tractography to be a useful tool for preoperatively predicting facial nerve displacement in vestibular schwannoma.
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Affiliation(s)
- Toshiaki Taoka
- Department of Radiology, Nara Medical University, Nara, and Higashiosaka City General Hospital, Osaka, Japan.
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