Facial nerve preservation with preoperative identification and intraoperative monitoring in large vestibular schwannoma surgery

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• 作者：YuHai Zhang (1)
  YiJun Chen (1)
  YuanJie Zou (1)
  WenBin Zhang (1)
  Rui Zhang (1)
  Xiang Liu (1)
  Zhuhai Lv (1)
  Kun Yang (1)
  Xinhua Hu (1)
  ChaoYong Xiao (2)
  Wen Liu (2)
  HongYi Liu (1)
  
• 关键词：Vestibular schwannoma ; Facial nerve ; Diffusion tensor tracking ; Intraoperative monitoring ; Microsurgery
• 刊名：Acta Neurochirurgica
• 出版年：2013
• 出版时间：October 2013
• 年：2013
• 卷：155
• 期：10
• 页码：1857-1862
• 全文大小：529KB
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  2. Gerganov VM, Giordano M, Samii M, Samii A (2011) Diffusion tensor imaging-based fiber tracking for prediction of the position of the facial nerve in relation to large vestibular schwannomas. J Neurosurg 115:1087-093 CrossRef
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  12. Taoka T, Hirabayashi H, Nakagawa H, Sakamoto M, Myochin K, Hirohashi S, Iwasaki S, Sakaki T, Kichikawa K (2006) Displacement of the facial nerve course by vestibular schwannoma: preoperative visualization using diffusion tensor tractography. J Magn Reson Imaging: JMRI 24:1005-010 CrossRef
  13. Yamakami I (2004) Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neurol Neurosurg Psychiatry 75:453-58 CrossRef
  
• 作者单位：YuHai Zhang (1)
  YiJun Chen (1)
  YuanJie Zou (1)
  WenBin Zhang (1)
  Rui Zhang (1)
  Xiang Liu (1)
  Zhuhai Lv (1)
  Kun Yang (1)
  Xinhua Hu (1)
  ChaoYong Xiao (2)
  Wen Liu (2)
  HongYi Liu (1)
  
  1. Department of Neurosurgery, Nanjing Medical University, Nanjing Brain Hospital, Nanjing, 210029, Jiangsu, China
  2. Department of Medical Imaging, Nanjing Medical University, Nanjing Brain Hospital, Nanjing, 210029, Jiangsu, China
  

文摘

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 (?0?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.