Download PDF
J Neurol Surg B Skull Base 2021; 82(04): 456-460
DOI: 10.1055/s-0040-1713103
Original Article

Facial Nerve Adherence in Vestibular Schwannomas: Classification and Radiological Predictors

Gustavo Simiano Jung
1   Department of Neurosurgery, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
,
Guilherme Ramina Montibeller
1   Department of Neurosurgery, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
,
Gabriel Schier de Fraga
2   Medicine Student, Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil
,
Thais dos Santos Rohde
3   Medicine Student, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
,
Ricardo Ramina
1   Department of Neurosurgery, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Facial nerve palsy is one of the most frequent complications after resection of vestibular schwannomas (VS). Several mechanisms have been implicated in the poor postoperative facial nerve outcome. Adherence between the facial nerve and tumor capsule is one of the most relevant factors. There is no clear preoperative parameter permitting identification of these adhesions.

Objective The aim of this study was to identify the correlation between the grade of adherence of the facial nerve to the tumor capsule and its functional outcome after VS resection.

Methods A total of 26 patients with sporadic VS (tumor sized T3, T4A, and T4B according to Hannover classification) were evaluated. Grade of adherence of the facial nerve to the tumor capsule was checked during surgery and graduated according to a proposed scale into 1 to 3 different grades. Facial nerve function was assessed postoperatively and after 1-year follow-up. Size of tumor according to Hannover classification, presence of cystic components, “cerebrospinal fluid (CSF) cleft sign,” and the contour of tumor capsule were tested as radiological predictors of grade of adherence to the facial nerve.

Results and Conclusion Only Grade 2 (11 cases) and 3 (15 cases) of adherence were seen in large VS. Lower grade of adherence was associated with good facial nerve outcome after 1-year follow-up (p = 0.029). Presence of the “CSF cleft sign” and regular contour of tumor capsule were independent predictors of adherence. When both factors were associated, sensitivity and specificity of this method were 83 and 80%, respectively.

Keywords

acoustic neuroma - facial nerve - facial paralysis - facial nerve injuries

Authors' Contributions

G.S.J. supported in drafting the article or revising it critically for important intellectual content. G.S.J., G.R.M., G.S.F., and T.S.R. dedicated in substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. R.R. prepared final approval of the version to be published.




Publication History

Received: 05 November 2019

Accepted: 12 April 2020

Article published online:
01 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ginzkey C, Scheich M, Harnisch W. et al. Outcome on hearing and facial nerve function in microsurgical treatment of small vestibular schwannoma via the middle cranial fossa approach. Eur Arch Otorhinolaryngol 2013; 270 (04) 1209-1216
    CrossrefPubMedGoogle Scholar
  • 2 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve--preservation and restitution of function. Neurosurgery 1997; 40 (04) 684-694 , discussion 694–695
    CrossrefPubMedGoogle Scholar
  • 3 Breun M, Nickl R, Perez J. et al. Vestibular schwannoma resection in a consecutive series of 502 cases via the retrosigmoid approach: technical aspects, complications, and functional outcome. World Neurosurg 2019; 129: e114-e127
    CrossrefPubMedGoogle Scholar
  • 4 Marenda SA, Olsson JE. The evaluation of facial paralysis. Otolaryngol Clin North Am 1997; 30 (05) 669-682
    CrossrefPubMedGoogle Scholar
  • 5 Fenton JE, Chin RY, Kalamarides M, Sterkers O, Sterkers JM, Fagan PA. Delayed facial palsy after vestibular schwannoma surgery. Auris Nasus Larynx 2001; 28 (02) 113-116
    CrossrefPubMedGoogle Scholar
  • 6 Bozorg Grayeli A, Kalamarides M, Fraysse B. et al. Comparison between intraoperative observations and electromyographic monitoring data for facial nerve outcome after vestibular schwannoma surgery. Acta Otolaryngol 2005; 125 (10) 1069-1074
    CrossrefPubMedGoogle Scholar
  • 7 Seo JH, Jun BC, Jeon EJ, Chang KH. Predictive factors influencing facial nerve outcomes in surgery for small-sized vestibular schwannoma. Acta Otolaryngol 2013; 133 (07) 722-727
    CrossrefPubMedGoogle Scholar
  • 8 Tatagiba M, Acioly MA. . Vestibular schwannoma: current state of the art. In: Ramina R, de Aguilar PR, Tatagiba M. eds. Samii's Essentials in Neurosurgery. 2nd ed. Berlin Heidelberg: Springer-Verlag; 2014: 265-283
  • 9 Leal AG, Silva Jr EB, Ramina R. Surgical exposure of the internal auditory canal through the retrosigmoid approach with semicircular canals anatomical preservation. Arq Neuropsiquiatr 2015; 73 (05) 425-430
    PubMedGoogle Scholar
  • 10 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
    CrossrefPubMedGoogle Scholar
  • 11 Neiss WF, Guntinas Lichius O, Angelov DN, Gunkel A, Stennert E. The hypoglossal-facial anastomosis as model of neuronal plasticity in the rat. Ann Anat 1992; 174 (05) 419-433
    CrossrefPubMedGoogle Scholar
  • 12 Kumral TL, Uyar Y, Berkiten G. et al. How to rehabilitate long-term facial paralysis. J Craniofac Surg 2015; 26 (03) 831-835
    CrossrefPubMedGoogle Scholar
  • 13 Bernat I, Grayeli AB, Esquia G, Zhang Z, Kalamarides M, Sterkers O. Intraoperative electromyography and surgical observations as predictive factors of facial nerve outcome in vestibular schwannoma surgery. Otol Neurotol 2010; 31 (02) 306-312
    CrossrefPubMedGoogle Scholar
  • 14 Myckatyn TM, Mackinnon SE. A review of facial nerve anatomy. Semin Plast Surg 2004; 18 (01) 5-12
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Lang J. Anatomy of the brainstem and the lower cranial nerves, vessels, and surrounding structures. Am J Otol 1985; 1-19
    PubMedGoogle Scholar
  • 16 Ohata K, Tsuyuguchi N, Morino M. et al. A hypothesis of epiarachnoidal growth of vestibular schwannoma at the cerebello-pontine angle: surgical importance. J Postgrad Med 2002; 48 (04) 253-258 , discussion 258–259
    PubMedGoogle Scholar
  • 17 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74 (04) 491-516
    CrossrefPubMedGoogle Scholar
  • 18 Piccirillo E, Wiet MR, Flanagan S. et al. Cystic vestibular schwannoma: classification, management, and facial nerve outcomes. Otol Neurotol 2009; 30 (06) 826-834
    CrossrefPubMedGoogle Scholar
  • 19 Osborn AG, Thurnher MM. Section 4: Skull, scalp, and meninges. Meningioma. In: Osborn AG, Jhaveri MD, Salzman KL. Diagnostic Imaging: Brain. 3rd ed. Salt Lake City: Elsevier; 2013: 1166-1171
    Google Scholar
  • 20 de Vries M, Hogendoorn PC, Briaire-de Bruyn I, Malessy MJ, van der Mey AG. Intratumoral hemorrhage, vessel density, and the inflammatory reaction contribute to volume increase of sporadic vestibular schwannomas. Virchows Arch 2012; 460 (06) 629-636
    CrossrefPubMedGoogle Scholar
  • 21 de Vries WM, Briaire-de Bruijn IH, van Benthem PPG, van der Mey AGL, Hogendoorn PCW. M-CSF and IL-34 expression as indicators for growth in sporadic vestibular schwannoma. Virchows Arch 2019; 474 (03) 375-381
    CrossrefPubMedGoogle Scholar