Evaluation of the Microsurgery Results for Acoustic Neuroma Using an Intraoperative Nerve Monitoring System (original) (raw)
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A Review of Facial Nerve Outcome in 100 Consecutive Cases of Acoustic Tumor Surgery
The Laryngoscope, 2000
To determine the facial nerve outcomes at a tertiary neurotological referral center specializing in acoustic neuroma and skull base surgery. Study Design: Retrospective review of 100 consecutive patients in whom acoustic neuromas were removed using all of the standard surgical approaches. Methods: Functional facial nerve outcomes were independently assessed using the House-Brackmann facial nerve grading system. Results: The tumors were categorized as small, medium, large, and giant. If one excludes the three patients with preoperative facial palsies, 100% of the small tumors, 98.6% of the medium tumors, 100% of the large tumors, and 71% of the giant tumors had facial nerve function grade I-II/VI after surgery. Conclusion: Facial nerve results from alternative nonsurgical treatments must be compared with facial nerve outcomes from experienced surgical centers. Based on the facial nerve outcomes from our 100 consecutive patients, microsurgical resection remains the preferred treatment modality for acoustic tumors. Key Words: Acoustic neuroma surgery, facial nerve outcome, facial nerve paralysis, translabyrinthine approach, retrosigmoid approach.
Cranial nerve preservation in surgery for large acoustic neuromas
Skull Base Surgery
Facial nerve outcomes and surgical complication rates for other cranial nerves were evaluated retrospectively after the resection of large acoustic neuromas. The charts of all patients who underwent surgical removal of an acoustic neuroma between 1992 and 2001 at New York University Medical Center were reviewed. Fifty-four patients with tumors measuring 3 cm or larger were included in the study. Four patients had neurofibromatosis type 2, two of whom underwent bilateral removal of acoustic neuromas. Translabyrinthine microsurgical removal of tumor was performed in 47 of 56 cases (84%). In all cases, EMG monitoring, improved sharp microdissection, and ultrasonic aspiration were employed. Facial nerve function was assessed using the House-Brackmann facial nerve grading system immediately after surgery and at follow-up visits. A House-Brackmann grade III or better was achieved in 90% of patients, and a grade II or better was achieved in 84% of patients. Ultimate facial nerve outcome wa...
Long-term results of the first 500 cases of acoustic neuroma surgery
Otolaryngology - Head and Neck Surgery, 2001
OBJECTIVE: this retrospective study focuses on 2 outcome results after surgical Intervention for acoustlo neuroma: (1) facial nerve status, and (2) hearing preservation. STUOY DESIGN: A total of 484 patients with an acoustic neuroma. RESULTS: Postoperative facial nerve outcom.. were IIgnltfcanfly different (P< 0,007) according to the size of the tumors. Tumor IIze had even more Intluence on the immediate poIfoperaflve ffIIUlfI. In addition, Bfafllflcal slgnltfcance (P < 0.05) WQI demonltrafed In comparing facial nerve outcom.. with the sur-Qeon', surgical experience, we also noted #hat as lire patient's age Inct'ease6, the HkeIIhood lor facial dyafunctlon may Inc.. . lor all poItoperatIve Inter-WJII. 7he overall success rate 01retainingUI8IuI hearIng was 27'1, (26 0196). Class A IIearIng was retained In 66'1, (1001 75)of easel operated on thlOUQh middle folia aPPfOOCh In the 1a115 yecn. CONCLUSION: this study demonstrates that tumor lIze and surgeon's experience are the moat IIgnlflcant factors Influencing the facial nerve status and hearing outcome after removal of acoustic neuroma.
Journal of Neurological Surgery Part B: Skull Base, 2017
This study analyzes the simple ratio of anterior-to-posterior extension of large (>2.5 cm) acoustic neuromas relative to the internal auditory canal (ICA; anterior–posterior [A/P] index) as a tool for predicting risk of facial nerve (FN) injury. In total, 105 patients who underwent microsurgical resection for large acoustic neuromas were analyzed retrospectively. House–Brackmann (HB) scores were assessed immediately postoperatively, at 1 month, and at 1 year. Lateral–medial, inferior–superior, A/P, and maximum diameters were measured from preoperative magnetic resonance images. These measurements and the A/P index were analyzed using univariable and multivariable statistical models to assess relationship to FN outcomes. The retrosigmoid, translabyrinthine, and combined approaches were used, and the extent of resection was evaluated. For every 1 standard deviation increase in the A/P index, a patient was 3.87 times more likely have a higher postoperative HB score (p < 0.0001). ...
Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery
Otolaryngologic clinics of North America, 1992
The likelihood of successful preservation of facial and cochlear nerve function during acoustic neuroma surgery has been improved by the advent of intraoperative monitoring techniques. The facial nerve is monitored by recording EMG from facial muscles, with no muscle relaxants used; mechanical irritation of the nerve during surgery causes increased EMG activity, which can be detected in real time using a loudspeaker. Brief episodes of activity associated with specific surgical maneuvers aid the surgeon in avoiding damage to the nerve, whereas prolonged tonic EMG activity may reflect significant neural injury. Electrical stimulation with a hand-held probe elicits evoked EMG responses, which can be used to locate and map the nerve in relation to the tumor. The threshold for eliciting evoked EMG responses provides a rough indicator of the functional status of the nerve. Different nerves in the posterior fossa (trigeminal, facial, spinal accessory) can be identified in multichannel reco...
Surgical outcome of Acoustic Neuroma Surgery in a Malaysian Tertiary Hospital
2023
Gadolinium enhanced magnetic resonance imaging (MRI) of the internal acoustic meatus and cerebellopontine angle helped in the diagnosis. 7 Histopathological examination of AN revealed two different appearances, namely Antoni A and Antoni B types. 8 Treatment options were mainly done conservatively or by surgical excision. 9 There were many factors that influences the choice of treatment. There are a few common complications that arise following surgery, namely facial nerve paresis, cerebrospinal fluid leakage and meningitis. 10 To date, there are three Malaysian studies on AN surgery. 11,12,13 The aim of this study is to describe the clinical characteristics of AN and the outcomes of AN surgery in a tertiary hospital in Malaysia.
Staged resection of large acoustic neuromas
Otolaryngology - Head and Neck Surgery, 2005
OBJECTIVE: Surgical removal of large (>3 cm) acoustic neuromas is associated with poor longterm facial nerve function results and higher complication rates. This study analyzes whether long term facial nerve function and the incidence of neurological and vascular complications is improved by resection of large acoustic neuromas in 2 or 3 stages.