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Preservation of facial function during removal of acoustic neuromas

Use of monopolar constant-voltage stimulation and EMG

Aage R. Møller and Peter J. Jannetta

output setting of the stimulator while the stimulus is used for identification of regions where there is no nerve or for identification of the nerve. The possibility of identifying areas of the tumor where there are no portions of the facial nerve present has made it possible to remove large parts of the tumor without risking damage to the facial nerve. The reduction in the duration of the operation is substantial, in some cases by as much as a factor of two. None of the patients has suffered permanent loss of facial function and none had any facial muscle weakness

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Hiroshi K. Inoue

stable in six and decreased in eight ( Fig. 1 .) In one patient microsurgery was conducted 2 years after radiosurgery because of tumor enlargement. No new persistent trigeminal, facial, or lower cranial nerve palsies developed after GKS. None of the 11 patients who underwent pre-GKS microsurgery experienced any postradiosurgery facial function deterioration. One of five patients with functional pre-GKS hearing lost his hearing 2 years after radiosurgery. Hearing was preserved in the remaining four patients after GKS for up to 13 years ( Table 1 .) TABLE 1

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Madjid Samii, Venelin Gerganov and Amir Samii

surgery, excellent facial nerve function (House–Brackmann Grades I and II) was present in 59% of patients, good function (House–Brackmann Grade III) in 16%, fair (House–Brackmann Grade IV) in 17%, and poor (House–Brackmann Grade V) or no function (House–Brackmann Grade VI) in 8%. If patients with a preoperative facial palsy are excluded from analysis, the rate of excellent facial function 2 weeks postoperatively is 62%. Five patients (3%) had complete facial palsy. The best functional results were achieved in patients treated for VS Class T1 or Class T3a: excellent

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Simone A. Betchen, Jane Walsh and Kalmon D. Post

either a translabyrinthine or suboccipital approach. Wounds were closed with cranioplasty, fascial closure, and tight skin closure. The questionnaire consisted of the SF-36 QOL measures and seven additional questions ( Table 1 ). TABLE 1 Additional questions used with the SF-36 to measure QOL in patients who underwent acoustic neuroma surgery 1. What influences most how you feel about surgery? a. facial function b. length of hospital stay c. relationship with doctor d. hearing e. headaches 2. What other options were you

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Richard H. Lye, John Dutton, Richard T. Ramsden, Joseph V. Occleshaw, Iain T. Ferguson and Ian Taylor

ease of access (large tumors) or because there was a hope (not realized) that useful hearing might be preserved. Patients were placed in the “park bench” position for the suboccipital approach. The preoperative assessment of facial function included either cine film or photographs of standard facial expressions (at rest, smiling, pouting, eyes closed) and these were repeated within 1 month postoperatively. An independent observer (R.H.L.) assessed facial function by review of these photographs and the case histories. All patients underwent CT scanning (EMI 1010

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Fumiko Higashiyama, Nanae Fukushima, Kumiko Yokouchi, Kyutaro Kawagishi and Tetsuji Moriizumi

branch has revealed that the total number of the tracer-labeled facial motor neurons of the nerve-crushed neonatal rats were 10% of the normal value of the age-matched control rats, indicating that the facial function, although not normal, can be preserved with a small population of motor neurons. 10 No data are heretofore available about the functional recovery and the number of surviving motor neurons with regenerated axonal fibers in cases of the facial nerve transection or resection during the neonatal stage. According to our preliminary experiments, the facial

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Douglas E. Anderson, John Leonetti, Joshua J. Wind, Denise Cribari and Karen Fahey

their own perceptions of their functional outcome as compared to the clinicians' observations ( Table 1 ). All patients were initially mailed questionnaires, and those failing to respond to the initial mailing were contacted again. The questionnaire consisted of closed and openended questions. The patients were asked to assess their facial functioning and recovery. This information was then converted into House—Brackmann grades. TABLE 1 Facial Nerve Questionnaire (It is important that all questions be completed.) 1

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Frederic Venail, Pascal Sabatier, Michel Mondain, François Segniarbieux, Christophe Leipp and Alain Uziel

.7%, and in the mastoid process in 16.7%. TABLE 1: Summary of cases with recovery of facial nerve function * Facial Function (Grade/%) Cause of Facial Palsy Duration of Preop Facial Palsy (mos) Preop 6 mos Postop 12 mos Postop 24 mos Postop VS/TLA 12 5/18 5/14 5/28 4/34 FS/TLA 0 NA † 6/9 5/14 4/25 VS/TLA 7 6/6 5/17 5/20 4/35 VS/TLA 21 6/7 5/22 4/32 3/50 astrocytoma 36 6/7 5/21 4/34 3/51 medulloblastoma 48 5/20 5/19 4/38 3/53 middle ear

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Donald L. Erickson, James I. Ausman and Shelley N. Chou

nerve function in the immediate postoperative period. Two of them had some facial function initially but lost it within the next several days following surgery. Eight of the patients had postoperative EMG evidence of absence of seventh nerve function. Recovery of seventh nerve function fell into two distinct time periods. One group of four patients began showing clinical recovery within 2 to 3 months after surgery, followed by a progressive and reasonably rapid improvement thereafter. The second group had no evidence of clinical recovery for 1 year after surgery

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Michael J. Ebersold and Lynn M. Quast

A natomical preservation of the facial nerve with maximum facial function is one of the goals of posterior fossa surgery. The routine use of the operating microscope, electrophysiological monitoring, and subspecialization has helped to achieve this goal. 4–6 In spite of these advances, complete facial nerve loss occasionally occurs following trauma or removal of malignant or benign lesions of the posterior fossa and temporal bone region. Sometimes primary repair of the facial nerve is possible at the time of the anatomical transection and, if either an end