Daniel P Nadeau1, Robert T Sataloff. 1. Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVE: To assess facial nerve function after fascicle preservation surgery in cases of facial nerve neuroma involving the cerebellopontine angle. STUDY DESIGN: Retrospective case series and literature review. SETTING: Tertiary referral center. PATIENTS: Seven patients with facial nerve neuroma involving the posterior cranial fossa were reviewed from a single neurotologist's practice and combined with a review of 648 cases reported in the literature. INTERVENTIONS: Translabyrinthine resection was used in all patients for complete tumor removal. Nerve reconstruction was accomplished with fascicle preservation (three cases), cable nerve interposition grafting (three cases, one of which involved using cranial nerve VIII as the graft), or direct anastomosis (one case). MAIN OUTCOME MEASURE: Facial nerve function as measured by the House-Brackmann grading system. RESULTS A postoperative facial nerve (House-Brackmann) grade of II/VI was obtained in two of our three patients who underwent fascicle preservation reconstruction and in two of eight cases reported by other authors. One case reported elsewhere resulted in grade I/VI, and four other cases reported elsewhere achieved grade III/VI; only two cases were grade V/VI. There were no tumor recurrences at 5 to 19 years of follow-up. CONCLUSION: Most cases of facial nerve neuroma require facial nerve resection. In rare cases, these tumors can be dissected away from the nerve fascicles, allowing the surgeon to preserve the facial nerve. This method resulted in better long-term postoperative facial nerve function (House-Brackmann grade II/VI vs. grade III/VI) compared with other techniques for patients in this small series, and no tumor recurrence.
OBJECTIVE: To assess facial nerve function after fascicle preservation surgery in cases of facial nerve neuroma involving the cerebellopontine angle. STUDY DESIGN: Retrospective case series and literature review. SETTING: Tertiary referral center. PATIENTS: Seven patients with facial nerve neuroma involving the posterior cranial fossa were reviewed from a single neurotologist's practice and combined with a review of 648 cases reported in the literature. INTERVENTIONS: Translabyrinthine resection was used in all patients for complete tumor removal. Nerve reconstruction was accomplished with fascicle preservation (three cases), cable nerve interposition grafting (three cases, one of which involved using cranial nerve VIII as the graft), or direct anastomosis (one case). MAIN OUTCOME MEASURE: Facial nerve function as measured by the House-Brackmann grading system. RESULTS A postoperative facial nerve (House-Brackmann) grade of II/VI was obtained in two of our three patients who underwent fascicle preservation reconstruction and in two of eight cases reported by other authors. One case reported elsewhere resulted in grade I/VI, and four other cases reported elsewhere achieved grade III/VI; only two cases were grade V/VI. There were no tumor recurrences at 5 to 19 years of follow-up. CONCLUSION: Most cases of facial nerve neuroma require facial nerve resection. In rare cases, these tumors can be dissected away from the nerve fascicles, allowing the surgeon to preserve the facial nerve. This method resulted in better long-term postoperative facial nerve function (House-Brackmann grade II/VI vs. grade III/VI) compared with other techniques for patients in this small series, and no tumor recurrence.
Authors: Beth N McNulty; Sean Wise; David S Cohen; Jason Bell; Dennis Bojrab; Michael LaRouere; Matthew Kircher; Seilesh Babu Journal: J Neurol Surg B Skull Base Date: 2017-01-30