Nervus intermedius dysfunctions after vestibular schwannoma surgery: a prospective clinical study

Restricted access

OBJECTIVE

The purpose of this prospective study was to evaluate the dysfunction of the nervus intermedius (NI) after vestibular schwannoma (VS) surgery. The authors present a clinically feasible method for this purpose.

METHODS

In this prospective study, the authors included 30 patients who underwent surgery at the International Neuroscience Institute between May 2014 and February 2017 for resection of VS. The patients’ taste sensation was examined using taste strips. Lacrimation was tested using the Schirmer I test. The clinical evaluation was performed before surgery and repeated at 2 weeks and at 6 months after surgery as well as during the follow-up, which extended up to 2 years. The authors tested the correlation between the NI dysfunctions and the House-Brackmann grade of facial nerve palsy.

RESULTS

The taste sensation was lost on the side of surgery in 2 patients (6.6%) and decreased in 4 patients (13.3%). The disturbance of taste sensation was not statistically correlated with dysfunctions of the motor portion of the facial nerve. The taste impairment resolved in 4 patients within 6 months, but 2 patients suffered from persistent loss of the taste sensation on the side of surgery during the follow-up. In 23 patients (76.6%), the baseline lacrimation was lower on the side of surgery, and it was significantly correlated with outcome for dysfunctions of the motor portion of the facial nerve. During the follow-up, baseline lacrimation improved in correlation with the improvement in the dysfunctions of the motor portion of the facial nerve. None of the patients reported change in salivation or nasal secretion.

CONCLUSIONS

The NI can be affected after VS surgery. The disturbance of baseline lacrimal secretion was correlated with dysfunctions of the motor portion of the facial nerve. However, the disturbance of the taste sensation was not correlated with the grade of facial nerve palsy. Dysfunctions of the NI should be evaluated and separately reported while analyzing facial nerve outcome after VS surgery.

ABBREVIATIONS HB = House-Brackmann; NI = nervus intermedius; VS = vestibular schwannoma.

Article Information

Correspondence Hussam Metwali: International Neuroscience Institute, Hannover, Germany. drhussamm@yahoo.com.

INCLUDE WHEN CITING Published online September 7, 2018; DOI: 10.3171/2018.4.JNS1818.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    Alfieri AFleischhammer JPeschke EStrauss C: The nervus intermedius as a variable landmark and critical structure in cerebellopontine angle surgery: an anatomical study and classification. Acta Neurochir (Wien) 154:126312682012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Alfieri AFleischhammer JPrell J: The functions of the nervus intermedius. AJNR Am J Neuroradiol 32:E144E1452011

  • 3

    Alfieri AStrauss CPrell JPeschke E: History of the nervus intermedius of Wrisberg. Ann Anat 192:1391442010

  • 4

    Boessert PGrüttner Cvan Ewijk RHaxel B: [Changes in taste ability in patients with vestibular schwannoma.] Laryngorhinootologie 93:4504542014 (Ger)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Carlson MLTveiten OVDriscoll CLGoplen FKNeff BAPollock BE: Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg 122:8338422015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Gerganov VMKlinge PMNouri MStieglitz LSamii MSamii A: Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery. Acta Neurochir (Wien) 151:5815872009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    House JWBrackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:1461471985

  • 8

    Irving RMViani LHardy DGBaguley DMMoffat DA: Nervus intermedius function after vestibular schwannoma removal: clinical features and pathophysiological mechanisms. Laryngoscope 105:8098131995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Landis BNWelge-Luessen ABrämerson ABende MMueller CANordin S: “Taste Strips”— a rapid, lateralized, gustatory bedside identification test based on impregnated filter papers. J Neurol 256:2422482009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Li NDeng XGHe MF: Comparison of the Schirmer I test with and without topical anesthesia for diagnosing dry eye. Int J Ophthalmol 5:4784812012

    • Search Google Scholar
    • Export Citation
  • 11

    Madge SNMalhotra RDesousa JMcNab AO’Donnell BDolman P: The lacrimal bypass tube for lacrimal pump failure attributable to facial palsy. Am J Ophthalmol 149:1551592010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Nakamizo AYoshimoto KAmano TMizoguchi MSasaki T: Crocodile tears syndrome after vestibular schwannoma surgery. J Neurosurg 116:112111252012

  • 13

    Noonan KYRang CCallahan KSimmons NEErkmen KSaunders JE: Nervus intermedius symptoms following surgical or radiation therapy for vestibular schwannoma. Otolaryngol Head Neck Surg 155:6576622016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Park SHLee KYHwang SK: Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma. J Neurosurg 118:5665702013

  • 15

    Rhoton AL JrKobayashi SHollinshead WH: Nervus intermedius. J Neurosurg 29:6096181968

  • 16

    Sahu RNBehari SAgarwal VKGiri PJJain VK: Taste dysfunction in vestibular schwannomas. Neurol India 56:42462008

  • 17

    Samii MGerganov VSamii A: Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 105:5275352006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Samii MMatthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve—preservation and restitution of function. Neurosurgery 40:6846951997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Samii MMatthies CTatagiba M: Management of vestibular schwannomas (acoustic neuromas): auditory and facial nerve function after resection of 120 vestibular schwannomas in patients with neurofibromatosis 2. Neurosurgery 40:6967061997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Stripf TBraun KGouveris HStripf EAMann WJAmedee RG: Influence of different approaches to the cerebellopontine angle on the function of the intermediate nerve. J Neurosurg 107:9279312007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Tamura MMurata NHayashi MRégis J: Injury of the lacrimal component of the nervus intermedius function after radiosurgery versus microsurgery. Neurochirurgie 50:3383442004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Tubbs RSSteck DTMortazavi MMCohen-Gadol AA: The nervus intermedius: a review of its anatomy, function, pathology, and role in neurosurgery. World Neurosurg 79:7637672013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    van Leeuwen BMHerruer JMPutter HJansen JCvan der Mey AGKaptein AA: Validating the Penn Acoustic Neuroma Quality Of Life Scale in a sample of Dutch patients recently diagnosed with vestibular schwannoma. Otol Neurotol 34:9529572013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Watanabe KSaito NTaniguchi MKirino TSasaki T: Analysis of taste disturbance before and after surgery in patients with vestibular schwannoma. J Neurosurg 99:99910032003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 52 52 52
Full Text Views 15 15 15
PDF Downloads 35 35 35
EPUB Downloads 0 0 0

PubMed

Google Scholar