Interface between the facial nerve and large acoustic neurinomas Immunohistochemical study of the cleavage plane in NF2 and non-NF2 cases

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✓ In acoustic neurinoma surgery, the surgeon is required to find a cleavage plane between the facial nerve and the tumor, and with the aid of the operating microscope this is usually achieved by fine dissection. A histological specimen of the nerve-tumor interface is available only if the facial nerve was hopelessly adherent to the tumor (usually a large or giant neoplasm) and the surgeon decided to sever the nerve to obtain a complete removal. The authors have examined immunohistochemically the nerve-tumor interface of 20 such facial nerves (six cases of neurofibromatosis 2 (NF2) and 14 of non-NF2) in a series of 351 acoustic neurinomas. The largest extrameatal dimension of the 20 tumors ranged from 20 to 51 mm (median 39 mm). In all of these 20 instances the nerve-tumor contact area was at least partially devoid of a clear-cut histological cleavage plane. Where the facial nerve trunk was attached to the surface of the tumor, nerve fibers of the contact areas either abutted directly against tumor cells or nerve fibers were seen to penetrate into the tumor tissue. Frank embedding of nerve fibers was more frequent in NF2.

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Address reprint requests to: Juha Jääskeläinen, M.D., Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki 26, Finland.

© AANS, except where prohibited by US copyright law.

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    Photomicrographs showing the nerve-tumor interface of severed facial nerve and acoustic neurinoma (see Tables 2 and 3). Immunoperoxidase staining against human 200-kD neurofilament protein stains nerve fibers brown in the hematoxylin-counterstained sections. a: Specimen from Case 21, a non-neurofibromatosis 2 (NF2) patient. The trunk of the facial nerve (n) adheres focally without a clear border to the tumor (t), and nerve fibers abut against tumor cells but are not embedded in the tumor tissue. × 68. b: Specimen from Case 13, a non-NF2 patient. Facial nerve fibers adhere more closely to the tumor tissue with a partially mixed interface. × 68. c: Specimen from left-sided tumor in Case 1, an NF2 patient. Facial nerve fibers (arrows) are embedded in the tumor tissue. × 68. d: Specimen from Case 14, a non-NF2 patient, showing the same appearance as in c. × 175. e: Specimen from Case 2, an NF2 patient. A transverse section of a small facial nerve neurinoma with nerve fibers spreading over the section but mostly pushed to the periphery. × 68.

References

1.

Baldwin DKing TTChevretton Eet al: Bilateral cerebellopontine angle tumors in neurofibromatosis type 2. J Neurosurg 74:9109151991Baldwin D King TT Chevretton E et al: Bilateral cerebellopontine angle tumors in neurofibromatosis type 2. J Neurosurg 74:910–915 1991

2.

Ebersold MJHarner SGBeatty CWet al: Current results of the retrosigmoid approach to acoustic neurinoma. J Neurosurg 76:9019091992Ebersold MJ Harner SG Beatty CW et al: Current results of the retrosigmoid approach to acoustic neurinoma. J Neurosurg 76:901–909 1992

3.

House JWBrackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:1461471985House JW Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147 1985

4.

Jääskeläinen JPyykkö IBlomstedt Get al: Functional results of facial nerve suture after removal of acoustic neurinoma: an analysis of 25 cases. Neurosurgery 27:4084111990Jääskeläinen J Pyykkö I Blomstedt G et al: Functional results of facial nerve suture after removal of acoustic neurinoma: an analysis of 25 cases. Neurosurgery 27:408–411 1990

5.

Lownie SPDrake CG: Radical intracapsular removal of acoustic neurinomas. Long-term follow-up review of 11 patients. J Neurosurg 74:4224251991Lownie SP Drake CG: Radical intracapsular removal of acoustic neurinomas. Long-term follow-up review of 11 patients. J Neurosurg 74:422–425 1991

6.

Luetje CMWhittaker CKCallaway LAet al: Histological acoustic tumor involvement of the VIIth nerve and multicentric origin in the VIIIth nerve. Laryngoscope 93:113311391983Luetje CM Whittaker CK Callaway LA et al: Histological acoustic tumor involvement of the VIIth nerve and multicentric origin in the VIIIth nerve. Laryngoscope 93:1133–1139 1983

7.

Marquet JFForton GEOffeciers FEet al: The solitary schwannoma of the eighth cranial nerve: an immunohistochemical study of the cochlear nerve-tumor interface. Arch Otolaryngol 116:102310251990Marquet JF Forton GE Offeciers FE et al: The solitary schwannoma of the eighth cranial nerve: an immunohistochemical study of the cochlear nerve-tumor interface. Arch Otolaryngol 116:1023–1025 1990

8.

Neely JG: Gross and microscopic anatomy of the eighth cranial nerve in relationship to the solitary schwannoma. Laryngoscope 91:151215311981Neely JG: Gross and microscopic anatomy of the eighth cranial nerve in relationship to the solitary schwannoma. Laryngoscope 91:1512–1531 1981

9.

Neely JG: Is it possible to totally resect an acoustic tumor and conserve hearing? Otolarygnol Head Neck Surg 92:1621671984Neely JG: Is it possible to totally resect an acoustic tumor and conserve hearing? Otolarygnol Head Neck Surg 92:162–167 1984

10.

Ojemann RGMartuza RL: Acoustic neuroma in Youmans JR (ed): Neurological Surgery. Philadelphia: WB Saunders1990 pp 33163350Ojemann RG Martuza RL: Acoustic neuroma in Youmans JR (ed): Neurological Surgery. Philadelphia: WB Saunders 1990 pp 3316–3350

11.

Sobel RAWang Y: Vestibular (acoustic) schwannomas: histologic features in neurofibromatosis 2 and in unilateral cases. J Neuropathol Exp Neurol 52:1061131993Sobel RA Wang Y: Vestibular (acoustic) schwannomas: histologic features in neurofibromatosis 2 and in unilateral cases. J Neuropathol Exp Neurol 52:106–113 1993

12.

Sugita KKobayashi S: Technical and instrumental improvements in surgical treatment of acoustic neurinomas. J Neurosurg 57:7477521982Sugita K Kobayashi S: Technical and instrumental improvements in surgical treatment of acoustic neurinomas. J Neurosurg 57:747–752 1982

13.

Symon LChessman ADKawauchi Met al: Neuromas of the facial nerve: a report of 12 cases. Br J Neurosurg 7:13221993Symon L Chessman AD Kawauchi M et al: Neuromas of the facial nerve: a report of 12 cases. Br J Neurosurg 7:13–22 1993

14.

Thomsen JTos MBørgesen SEet al: Surgical results after translabyrinthine removal of 504 acoustic neuromas in Tos MThomsen J (eds): Acoustic Neurinoma. Amsterdam: Kugler1992 pp 331335Thomsen J Tos M Børgesen SE et al: Surgical results after translabyrinthine removal of 504 acoustic neuromas in Tos M Thomsen J (eds): Acoustic Neurinoma. Amsterdam: Kugler 1992 pp 331–335

15.

Tos MThomsen J: Proposal of classification of tumor size in acoustic neuroma surgery in Tos MThomsen J (eds): Acoustic Neuroma. Amsterdam: Kugler1992 pp 133137Tos M Thomsen J: Proposal of classification of tumor size in acoustic neuroma surgery in Tos M Thomsen J (eds): Acoustic Neuroma. Amsterdam: Kugler 1992 pp 133–137

16.

Tos MThomsen JBørgesen SEet al: Management of giant acoustic neuroma in Tos MThomsen J (eds): Acoustic Neuroma. Amsterdam: Kugler1992 pp 365368Tos M Thomsen J Børgesen SE et al: Management of giant acoustic neuroma in Tos M Thomsen J (eds): Acoustic Neuroma. Amsterdam: Kugler 1992 pp 365–368

17.

Trofatter JAMacCollin MMRutter JLet al: A novel moesin-, ezrin-, radixin-like gene is a candidate for the neurofibromatosis 2 tumor suppressor. Cell 72:7918001993Trofatter JA MacCollin MM Rutter JL et al: A novel moesin- ezrin- radixin-like gene is a candidate for the neurofibromatosis 2 tumor suppressor. Cell 72:791–800 1993

18.

Whittaker CKLuetje CM: Vestibular schwannomas. J Neurosurg 76:8979001992 (Editorial)Whittaker CK Luetje CM: Vestibular schwannomas. J Neurosurg 76:897–900 1992 (Editorial)

19.

Ylikoski JCollan YPalva Tet al: Cochlear nerve in neurilemmomas. Arch Otolaryngol 104:6796841978Ylikoski J Collan Y Palva T et al: Cochlear nerve in neurilemmomas. Arch Otolaryngol 104:679–684 1978

20.

Ylikoski JPalva TCollan Y: Eighth nerve in acoustic neuromas. Arch Otolaryngol 104:5325371978Ylikoski J Palva T Collan Y: Eighth nerve in acoustic neuromas. Arch Otolaryngol 104:532–537 1978

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