Background: The surgery of cerebellopontine angle tumours has remarkably progressed
over the last 2 decades due to improved microsurgical techniques. The primary operative goals are microscopic total
removal of the tumour while securing the adjacent cranial nerves. Facial
Nerve plays a critical role in facial muscles function and one’s cosmetic
appearance, and its weakness can have profound
implications on a patient’s quality of life. Aim of the Study: To assess the impact of monitoring techniques on the
preservation of facial nerve function during cerebellopontine angle
tumours surgery. Patients and Methods: This is a prospective study. This
study was conducted on 30 cases (2 groups, each
had 15 patients) with CPA lesions that had undergone surgical excision
of these lesions performed by retrosigmoid approach (Group A: the patients
were operated under continuous intraoperative facial nerve monitoring(IOFNM) and Group B: the patients were operated without IOFNM). Theywere operated upon in neurosurgery
departments at Al-Azhar university hospitals
between August 2019 and August 2021. Results: This study showed that excellent
facial nerve function (HB Grade I and II) was higher in group A than group B, immediately and at 6-month post op (80% and 93% VS 53.3%
and 66.7%). Intermediate (HB Grade III and VI) and
References
[1]
Heller, R.S., Silveira, L. and Heilman, C.B. (2018) Cerebellopontine Angle Tumors. Elsevier Inc., Amsterdam. https://doi.org/10.1016/B978-0-323-43140-8.00043-3
[2]
Ramsden, R.T. (1995) The Bloody Angle: 100 Years of Acoustic Neuroma Surgery. Journal of the Royal Society of Medicine, 88, 464-468.
[3]
Samii, M., Gerganov, V. and Samii, A. (2006) Improved Preservation of Hearing and Facial Nerve Function in Vestibular Schwannoma Surgery via the Retrosigmoid Approach in a Series of 200 Patients. Journal of Neurosurgery, 105, 527-535. https://doi.org/10.3171/jns.2006.105.4.527
[4]
Visagan, R., Hall, A., Bradford, R., Khalil, S. and Saeed, S.R. (2019) Is There a Difference in Hospital Stay between Patients Undergoing Translabyrinthine or Retrosigmoid Surgery for Vestibular Schwannoma Stratified by Tumor Size? Journal of Neurological Surgery Part B. Skull Base, 80, 310-315. https://doi.org/10.1055/s-0038-1668541
[5]
Jun, W., Gao, Y.L., Yu, H.G., et al. (2020) Comparison of Translabyrinthine and Retrosigmoid Approach for Treating Vestibular Schwannoma: A Meta-Analysis. Clinical Neurology and Neurosurgery, 196, Article ID: 105994. https://doi.org/10.1016/j.clineuro.2020.105994
[6]
Huang, X., Xu, M., Xu, J., et al. (2017) Complications and Management of Large Intracranial Vestibular Schwannomas via the Retrosigmoid Approach. World Neurosurgery, 99, 326-335. https://doi.org/10.1016/j.wneu.2016.12.055
[7]
Murphy, E.K. (2008) Use of an Infrared Camera to Improve the Outcome of Facial Nerve Monitoring. American Journal of Electroneurodiagnostic Technology, 48, 38-47. https://doi.org/10.1080/1086508X.2008.11079656
[8]
Taemin, O., Nagasawa, D.T., Fong, B.M., et al. (2011) Intraoperative Neuromonitoring Techniques in the Surgical Management of Acoustic Neuromas. Neurosurgical Focus, 33, E6. https://doi.org/10.3171/2012.6.FOCUS12194
[9]
Fong, B., Barkhoudarian, G., Pezeshkian, P., Parsa, A.T., Gopen, Q. and Yang, I. (2011) The Molecular Biology and Novel Treatments of Vestibular Schwannomas. A Review. Journal of Neurosurgery, 115, 906-914. https://doi.org/10.3171/2011.6.JNS11131
[10]
Kalamarides, M., Grayeli, A.B., Fraysse, B., Deguine, O., Favre, G., et al. (2005) Comparison between Intraoperative Observations and Electromyographic Monitoring Data for Facial Nerve Outcome after Vestibular Schwannoma Surgery. Acta Oto-Laryngologica, 125, 1069-1074. https://doi.org/10.1080/00016480510038608
[11]
Isaacson, B., Kileny, P.R., El-Kashlan, H. and Gadre, A.K. (2003) Intraoperative Monitoring and Facial Nerve Outcomes after Vestibular Schwannoma Resection. Otology & Neurotology, 24, 812-817. https://doi.org/10.1097/00129492-200309000-00020
[12]
Marin, P., Pouliot, D. and Fradet, G. (2011) Facial Nerve Outcome with a Peroperative Stimulation Threshold under 0.05 ma. Laryngoscope, 121, 2295-2298. https://doi.org/10.1002/lary.22359
[13]
Noss, R.S., Lalwani, A.K. and Yingling, C.D. (2001) Facial Nerve Monitoring in Middle Ear and Mastoid Surgery. Laryngoscope, 111, 831-836. https://doi.org/10.1097/00005537-200105000-00014
[14]
Chen, Z., Prasad, S.C., Di Lella, F., Medina, M., Piccirillo, E., Taibah, A., Russo, A., Yin, S. and Sanna, M. (2014) The Behavior of Residual Tumors and Facial Nerve Outcomes after Incomplete Excision of Vestibular Schwannomas. Journal of Neurosurgery, 120, 1278-1287. https://doi.org/10.3171/2014.2.JNS131497
Tatagiba, M. and Acioly, M.A. (2008) Vestibular Schwannoma: Current State of the Art. In: Ramina, R., Pires Aguiar, P.H. and Tatagiba, M., Eds., Samii’s Essentials in Neurosurgery, Springer, Stuttgart, 175-188. https://doi.org/10.1007/978-3-540-49250-4_18
[17]
Fenton, J.E., Chin, R.Y., Fagan, P.A., Sterkers, O. and Sterkers, J.M. (2002) Predictive Factors of Long-Term Facial Nerve Function after Vestibular Schwannoma Surgery. Otology & Neurotology, 23, 388-392. https://doi.org/10.1097/00129492-200205000-00027
[18]
Zamani, A.A. (2000) Cerebellopontine Angle Tumors: Role of Magnetic Resonance Imaging. Topics in Magnetic Resonance Imaging, 11, 98-107. https://doi.org/10.1097/00002142-200004000-00005
[19]
Matthies, C. and Samii, M. (1997) Management of 1000 vs (Acoustic Neuromas): Clinical Presentation. Neurosurgery, 40, 1-10. https://doi.org/10.1227/00006123-199701000-00001
[20]
Falcioni, M., Fois, P., Taibah, A. and Sanna, M. (2011) Facial Nerve Function after Vestibular Schwannoma Surgery. Journal of Neurosurgery, 115, 820-826. https://doi.org/10.3171/2011.5.JNS101597
[21]
Koos, W.T., Day, D.J., Matula, C. and Levy, D.I. (1998) Neurotopographic Considerations in the Microsurgical Treatment of Small Acoustic Neurinomas. Journal of Neurosurgery, 88, 506-512. https://doi.org/10.3171/jns.1998.88.3.0506
[22]
Rinaldi, V., Casale, M., Bressi, F., Potena, M., Vesperini, E., De Franco, A., Silvestri, S., Zini, C. and Salvinelli, F. (2012) Facial Nerve Outcome after Vestibular Schwannoma Surgery: Our Experience. Journal of Neurological Surgery Part B. Skull Base, 73, 21-27. https://doi.org/10.1055/s-0032-1304559
[23]
Taddei, G., Marrelli, A., Trovarelli, D., Ricci, A. and Galzio, R.J. (2016) Facial Functional Outcome in Monitored versus Not-Monitored Patients in VS Surgery. Asian Journal of Neurosurgery, 11, 402-406. https://doi.org/10.4103/1793-5482.144208
[24]
Youssef, A.S. and Downes, A.E. (2009) Intraoperative Neurophysiological Monitoring in Vestibular Schwannoma Surgery: Advances and Clinical Implications. Neurosurgical Focus, 27, E9. https://doi.org/10.3171/2009.8.FOCUS09144
[25]
Bloch, O., Sughrue, M.E., Kaur, R., Kane, A.J., Rutkowski, M.J. and Kaur, G. (2011) Factors Associated with Preservation of Facial Nerve Function after Surgical Resection of Vestibular Schwannoma. Journal of Neuro-Oncology, 102, 281-286. https://doi.org/10.1007/s11060-010-0315-5
[26]
Breun, M., Nickl, R., Perez, J., Hagen, R., Löhr, M., Vince, G., Trautner, H., Ernestus, R.I. and Matthies, C. (2019) Vestibular Schwannoma Resection in a Consecutive Series of 502 Cases via the Retrosigmoid Approach: Technical Aspects, Complications, and Functional Outcome. World Neurosurgery, 129, e114-e127. https://doi.org/10.1016/j.wneu.2019.05.056
[27]
Jung, S., Kang, S.S., Kim, T.S., Kim, H.J., Jeong, S.K., Kim, S.C., Lee, J.K., Kim, J.H., Kim, S.H. and Lee, J.H. (2000) Current Surgical Results of Retrosigmoid Approach in Extralarge Vestibular Schwannoma. Surgical Neurology, 53, 370-378. https://doi.org/10.1016/S0090-3019(00)00196-8
[28]
Anaizi, A.N., Gantwerker, E.A., Pensak, M.L. and Theodosopoulos, P.V. (2014) Facial Nerve Preservation Surgery for Koos Grade 3 and 4 VS. Neurosurgery, 75, 671-675. https://doi.org/10.1227/NEU.0000000000000547
[29]
Schwartz, M.S., Kari, E., Strickland, B.M., Berliner, K., Brackmann, D.E., House, J.W. and Friedman, R.A. (2013) Evaluation of the Increased Use of Partial Resection of Large Vestibular Schwanommas: Facial Nerve Outcomes and Recurrence/Regrowth Rates. Otology & Neurotology, 34, 1456-1464. https://doi.org/10.1097/MAO.0b013e3182976552
[30]
Ferroli, P., Bosio, L. and Broggi, M. (2017) Facial Nerve Sparing Surgery for Large VS. Acta Neurochirurgica (Wien), 159, 1213-1218. https://doi.org/10.1007/s00701-017-3216-y
[31]
Vivas, E.X., Carlson, M.L., Neff, B.A., Shepard, N.T., McCracken, D.J., Sweeney, A.D. and Olson, J.J. (2018) Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Intraoperative Cranial Nerve Monitoring in Vestibular Schwannoma Surgery. Neurosurgery, 82, E44-E46. https://doi.org/10.1093/neuros/nyx513
[32]
Harner, S.G., Daube, J.R., Ebersold, M.J. and Beatty, C.W. (1987) Improved Preservation of Facial Nerve Function with Use of Electrical Monitoring during Removal of Acoustic Neuromas. Mayo Clinic Proceedings, 62, 92-102. https://doi.org/10.1016/S0025-6196(12)61876-X
[33]
Harner, S.G., Daube, J.R., Beatty, C.W. and Ebersold, M.J. (1988) Intraoperative Monitoring of the Facial Nerve. Laryngoscope, 98, 209-212. https://doi.org/10.1288/00005537-198802000-00018
[34]
Leonetti, J.P., Brackmann, D.E. and Prass, R.L. (1989) Improved Preservation of Facial Nerve Function in the Infratemporal Approach to the Skull Base. Otolaryngology—Head and Neck Surgery, 101, 74-78. https://doi.org/10.1177/019459988910100112
[35]
Hammerschlag, P.E. and Cohen, N.L. (1990) Intraoperative Monitoring of Facial Nerve Function in Cerebellopontine Angle Surgery. Otolaryngology—Head and Neck Surgery, 103, 681-684. https://doi.org/10.1177/019459989010300502