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Li Y, Peng H, Zhang S, Long W, Pan Y, Li Y, Wu C, Xiao K, Wang X, Su J, Qin C, Liu Q. Preservation of the integrity of facial nerve in vestibular schwannoma microsurgery: A consecutive study of 127 clinical cases focusing on nervus intermedius. Front Oncol 2023; 13:939983. [PMID: 36845752 PMCID: PMC9947554 DOI: 10.3389/fonc.2023.939983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Background Nervus intermedius (NI) injuries are not given enough attention by neurosurgeons during vestibular schwannoma (VS) surgery. Preservation of NI function is essential for the integrity and continuity of the facial nerve, although this can be challenging. We identified the risk factors for NI injury and proposed our experience for optimizing NI preservation based on our cases. Methods We retrospectively analyzed clinical data from a consecutive series of 127 patients with VS who underwent microsurgery via the retrosigmoid approach from 2017 to 2021 at our institution. The baseline characteristics of the patients were collected from the medical records, and the incidence of NI dysfunction symptoms was obtained by outpatient and online video follow-up 6 months after surgery. The surgical procedures and techniques used were described in detail. The data were analyzed in relation to sex, age, tumor location (left or right), Koos grading scale, internal acoustic canal (IAC) invasion (TFIAC Classification), brainstem adhesion, tumor characteristics (cystic or solid), tumor necrosis, and preoperative House-Brackmann (HB) grading by univariate and multivariate analyses. Results Gross tumor removal was achieved in 126 (99.21%) patients. Subtotal removal was performed on one patient (0.79%). Twenty-three of our cases exhibited facial nerve palsy preoperatively; 21 patients had HB grade II facial palsy, and two had HB grade III. Two months after surgery, 97 (76.38%) patients had normal function of the motor portion of the facial nerve; 25 (19.69%) patients had HB Grade II facial palsy, five had Grade III (3.94%), and zero (0%) had Grade IV. Postoperatively, 15 patients experienced newly gained dry eyes (11.81%), whereas 21 cases of lacrimal disturbances (16.54%), nine of taste disturbances (7.09%), seven of xerostomia (5.51%), five of nasal hypersecretions (3.94%), and seven of hypersalivation (5.51%) were identified in our cases. Univariate and multivariate analyses revealed that the Koos grading scale and tumor characteristics (solid or cystic) were correlated with NI injury (p <0.01). Conclusion The data in this study demonstrate that although the motor function of the facial nerve is well preserved, NI disturbance is still common after VS surgery. Maintaining the integrity and continuity of the facial nerve is key to NI function. Performing bidirectional and subperineurium dissection based on even and adequate debulking is beneficial for NI preservation in VS surgery. Higher Koos grading and cystic characteristics of VS are associated with postoperative NI injuries. These two parameters can be used to guide the delineation of surgical strategy and predict the prognosis of NI function preservation.
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Affiliation(s)
- Yue Li
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hao Peng
- Department of Neurosurgery, Hainan General Hospital, Haikou, Hainan, China
| | - Sen Zhang
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenyong Long
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yimin Pan
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Li
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Changwu Wu
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kai Xiao
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiangyu Wang
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun Su
- Department of Neurosurgery, Hunan Children’s Hospital, Changsha, Hunan, China
| | - Chaoying Qin
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China,*Correspondence: Qing Liu, ; Chaoying Qin,
| | - Qing Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, Hunan, China,Institute of Skull Base Surgery & Neuro-oncology at Hunan Neurosurgery Institute of Central South University, Changsha, Hunan, China,*Correspondence: Qing Liu, ; Chaoying Qin,
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Matsumoto S, Osawa K, Hirose Y, Nakayama M, Wada T, Matsuda M, Akutsu H, Ii R, Koizumi H, Okano Y, Tabuchi K. Objective evaluation of gustatory function after surgery for vestibular schwannoma: A pilot study. Auris Nasus Larynx 2021; 49:183-187. [PMID: 34148726 DOI: 10.1016/j.anl.2021.05.011] [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: 01/31/2021] [Revised: 04/17/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the gustatory function before and after vestibular schwannoma (VS) surgery. METHODS In this retrospective study, we evaluated the gustatory function of 12 patients who underwent VS surgery at Tsukuba University Hospital between 2012 and 2018. Gustatory function was examined using electrogustometry before VS surgery and 3 months, 6 months and 1 year after surgery. Electrogustometry was tested at the area mapped to the chorda tympani nerve, glossopharyngeal nerve and greater superficial petrosal nerve (GSPN). Intergroup mean comparisons of the threshold were performed using a one-way analysis of variance (ANOVA) followed by the Bonferroni post-hoc test. RESULTS The gustatory function mapped to the chorda tympani nerve was significantly disturbed 6 months after the surgery as compared with the preoperative function (p = 0.033) and that the dysfunction recovered at 1 year. However, gustatory function mapped to the glossopharyngeal nerve and greater superficial petrosal nerve (GSPN) was not impaired. CONCLUSION The gustatory function mapped to the chorda tympani nerve is impaired after surgery for VS. The dysfunction peaked at 6 months after surgery, and recovered within 1 year.
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Affiliation(s)
- Shin Matsumoto
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kotaro Osawa
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuki Hirose
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Nakayama
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuro Wada
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Rieko Ii
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hitoshi Koizumi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuhito Okano
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keiji Tabuchi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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