Preservation of the Facial Nerve during Acoustic Neuronoma Excision and Investigation of the Anatomical Location and Shape of Facial Nerve_West China Medical Journal

Authors：

 ZOULin-bo ^1,2 ,  ZHANGYue-kang ¹ , XUHong ² , HUIXu-hui ¹

1. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Neurosurgery, Deyang People's Hospital, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

ZHANGYue-kang, Email: lbzou21@163.com

Keywords：

Acoustic neurinoma; Microsurgery; Facial nerve; Monitoring

DOI：

10.7507/1002-0179.20150128

Video：

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Objective To study the anatomicopathological relation between facial nerve (FN) and acoustic neuronoma (AN) and summarize the techniques of how to protect facial nerves in microsurgery. Methods A retrospective analysis of 585 patients with acoustic neuronmas treated by microsurgery for the first time between January 2007 and March 2012 was carried out. Anatomicopathological relation between FN and AN and protection of the facial nerve were described. Results The tumors were totally removed microsurgically in 552 patients, and the total removal rate was 94.4%. Subtotal removal was performed in 33 patients. Facial nerve was anatomically preserved in 558 cases, and the rate of facial nerve preservation was 95.4%. After one-year follow-up, 549 patients had House-Brackmann Ⅰ-Ⅳ function. The location and shape of the FN along the tumor was identified as the follows: FN displaced along the ventral and superior surface of the tumor in 279 patients (47.7%), the ventral and central in 243 (41.5%), the ventral and inferior in 33 (5.6%), the dorsal in 10, the superior pole in 6, the inferior pole in 3, and FN surrounded in 11. Conclusion Good understanding of the meaning of anatomicopathological relation between FN and AN, intraoperative monitoring and perfect microneurosurgical skills are important in achieving the goal of total resection of acoustic neuromas and anatomic reservation of the facial nerve.

Citation： ZOULin-bo, ZHANGYue-kang, XUHong, HUIXu-hui. Preservation of the Facial Nerve during Acoustic Neuronoma Excision and Investigation of the Anatomical Location and Shape of Facial Nerve. West China Medical Journal, 2015, 30(3): 447-450. doi: 10.7507/1002-0179.20150128 Copy

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7.	Bae CW, Cho YH, Hong SH, et al. The anatomical location and course of the facial nerve in vestibular schwannomas:a study of 163 surgically treated cases[J]. J Korean Neurosurg Soc, 2007, 42(6):450-454.
8.	张跃康, 段劼. 巨大听神经瘤手术中面神经的保护[J]. 华西医学, 2008, 23(1):83-84.
9.	Zhang YH, Chen YJ, Zou YJ, et al. Facial nerve preservation with preoperative identification and intraoperative monitoring in large vestibular schwannoma surgery[J]. Acta Neurochir (Wien), 2013, 155(10):1857-1862.
10.	徐伟民, 蒋大介. 240例巨大听神经瘤的手术治疗[J]. 中华神经外科杂志, 1987(3):3-6.
11.	张远征, 周定标, 张纪, 等. 听神经瘤全切的面、耳蜗神经保留——(附33例随访报告)[J]. 中华神经外科杂志, 1993, 9(6):315-317.
12.	于春江, 王忠诚, 关树深, 等. 听神经瘤切除面神经保留技术探讨[J]. 中华神经外科杂志, 2001, 17(3):174-177.
13.	Dunn IF, Bi WL, Erkmen K, et al. Medial acoustic neuromas:clinical and surgical implications[J]. J Neurosurg, 2014, 120(5):1095-1104.
14.	Goldbrunner RH, Schlake HP, Milewski C, et al. Quantitative parameters of intraoperative electromyography predict facial nerve outcomes for vestibular schwannoma surgery[J]. Neurosurgery, 2000, 46(5):1140-1146.
15.	Yamakami I, Uchino Y, Kobayashi E, et al. Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity[J]. J Neurol Neurosurg Psychiatry, 2004, 75(3):453-458.

1. Mendenhall WM, Friedman WA, Amdur RJ, et al. Management of acoustic schwannoma[J]. Am J Otolaryngol, 2004, 25(1):38-47.
2. Koos WT, Matula C, Lang J. Color atalas of microneurosurgery of acoustic neurinomas[M]. Newyork:Gorg Thieme Verlag, 2002:22-90.
3. House JW, Brackmann DE. Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985, 93(2):146-147.
4. Bloch O, Sughrue ME, Kaur R, et al. Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma[J]. J Neurooncol, 2011, 102(2):281-286.
5. Strauss C. The facial nerve in medial acoustic neuromas[J]. J Neurosurg, 2002, 97(5):1083-1090.
6. Sampath P, Rini D, Long DM. Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas):a retrospective study of 1006 consecutive cases[J]. J Neurosurg, 2000, 92(1):70-78.
7. Bae CW, Cho YH, Hong SH, et al. The anatomical location and course of the facial nerve in vestibular schwannomas:a study of 163 surgically treated cases[J]. J Korean Neurosurg Soc, 2007, 42(6):450-454.
8. 张跃康, 段劼. 巨大听神经瘤手术中面神经的保护[J]. 华西医学, 2008, 23(1):83-84.
9. Zhang YH, Chen YJ, Zou YJ, et al. Facial nerve preservation with preoperative identification and intraoperative monitoring in large vestibular schwannoma surgery[J]. Acta Neurochir (Wien), 2013, 155(10):1857-1862.
10. 徐伟民, 蒋大介. 240例巨大听神经瘤的手术治疗[J]. 中华神经外科杂志, 1987(3):3-6.
11. 张远征, 周定标, 张纪, 等. 听神经瘤全切的面、耳蜗神经保留——(附33例随访报告)[J]. 中华神经外科杂志, 1993, 9(6):315-317.
12. 于春江, 王忠诚, 关树深, 等. 听神经瘤切除面神经保留技术探讨[J]. 中华神经外科杂志, 2001, 17(3):174-177.
13. Dunn IF, Bi WL, Erkmen K, et al. Medial acoustic neuromas:clinical and surgical implications[J]. J Neurosurg, 2014, 120(5):1095-1104.
14. Goldbrunner RH, Schlake HP, Milewski C, et al. Quantitative parameters of intraoperative electromyography predict facial nerve outcomes for vestibular schwannoma surgery[J]. Neurosurgery, 2000, 46(5):1140-1146.
15. Yamakami I, Uchino Y, Kobayashi E, et al. Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity[J]. J Neurol Neurosurg Psychiatry, 2004, 75(3):453-458.

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