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Facial nerve sparing surgery for large vestibular schwannomas

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Abstract

Background

Nowadays, there is a general trend in vestibular schwannoma (VS) surgery favoring near-total or subtotal tumor resection (NTR/STR) with facial nerve (FN) function preservation rather than gross total resection (GTR) with high risk of FN damage.

Methods

The surgical technique of FN sparing in large VS includes patient-tailored image-guided craniotomy, continuous intraoperative neurophysiological monitoring (INM), intracapsular wide tumor debulking, and only final extracapsular dissection with FN course identification and brainstem decompression. A small amount of residual tumor along the FN is accepted in order to not damage the nerve. Postoperative radiosurgery workup is then recommended.

Conclusions

NTR/STR resection with FN function sparing is a valid option for large VS.

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Abbreviations

CMC:

Cerebello-medullary cistern

CN:

Cranial nerve

CPA:

Cerebellopontine angle

CSF:

Cerebrospinal fluid

FM:

Foramen magnum

FN:

Facial nerve

GTR:

Gross total resection

IAC:

Internal acoustic canal

INM:

Intraoperative neurophysiological monitoring

MR:

Magnetic resonance

NTR:

Near-total resection

SPV:

Superior petrosal veins

SS:

Sigmoid sinus

STR:

Subtotal resection

TS:

Transverse sinus

VS:

Vestibular schwannoma

References

  1. Broggi G, Broggi M, Ferroli P, Franzini A (2012) Surgical technique for trigeminal microvascular decompression. Acta Neurochir 154(6):1089–1095

    Article  PubMed  Google Scholar 

  2. Gurgel RK, Dogru S, Amdur RL, Monfared A (2012) Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter? Neurosurg Focus 33(3):E16

    Article  PubMed  Google Scholar 

  3. House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93(2):146–147

    Article  CAS  PubMed  Google Scholar 

  4. Mendelsohn D, Westerberg BD, Dong C, Akagami R (2016) Clinical and radiographic factors predicting hearing preservation rates in large vestibular schwannomas. J Neurol Surg B Skull Base 77(3):193–198

    Article  PubMed  Google Scholar 

  5. Monfared A, Corrales CE, Theodosopoulos PV, Blevins NH, Oghalai JS, Selesnick SH, Lee H, Gurgel RK, Hansen MR, Nelson RF, Gantz BJ, Kutz JW Jr, Isaacson B, Roland PS, Amdur R, Jackler RK (2016) Facial nerve outcome and tumor control rate as a function of degree of resection in treatment of large acoustic neuromas: preliminary report of the acoustic neuroma subtotal resection study (ANSRS). Neurosurgery 79(2):194–203

    Article  PubMed  Google Scholar 

  6. Radwan H, Eisenberg MB, Sandberg Knisely JP, Ghaly MM, Schulder M (2016) Outcomes in patients with vestibular schwannoma after subtotal resection and adjuvant radiosurgery. Stereotact Funct Neurosurg 94(4):216–224

    Article  PubMed  Google Scholar 

  7. Schwartz MS, Kari E, Strickland BM, Berliner K, Brackmann DE, House JW, Friedman RA (2013) Evaluation of the increased use of partial resection of large vestibular schwannomas: facial nerve outcomes and recurrence/regrowth rates. Otol Neurotol 34(8):1456–1564

    Article  PubMed  Google Scholar 

  8. van de Langenberg R, Hanssens PE, van Overbeeke JJ, Verheul JB, Nelemans PJ, de Bondt BJ, Stokroos RJ (2011) Management of large vestibular schwannoma. Part I Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects. J Neurosurg 115(5):875–884

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy

    Paolo Ferroli, Lorenzo Bosio & Morgan Broggi

Authors
  1. Paolo Ferroli
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  2. Lorenzo Bosio
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  3. Morgan Broggi
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Corresponding author

Correspondence to Morgan Broggi.

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The manuscript has not been previously published in whole or in part or submitted for publication in any form.

Electronic supplementary material

The video shows the surgical technique for FN sparing during VS resection; preoperative MR shows a 3-cm right-side VS. Following position, neuronavigation, and craniotomy, the tumor is removed with intracapsular debulking under continuous functional FN INM. When the tumor becomes smaller and softer, it can be gently dissected from the brainstem. Before final tumor removal, the FN course is identified from its origin to the IAC and a small amount of tumor is left along the FN in order not to damage it. Postoperative MR confirms NTR of the tumor. Three weeks after surgery, the patient does not present any FN deficit. (MP4 162,834 kb)

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Ferroli, P., Bosio, L. & Broggi, M. Facial nerve sparing surgery for large vestibular schwannomas. Acta Neurochir 159, 1213–1218 (2017). https://doi.org/10.1007/s00701-017-3216-y

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  • DOI: https://doi.org/10.1007/s00701-017-3216-y

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