scholarly journals Complications of Microsurgery of Vestibular Schwannoma

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Jan Betka ◽  
Eduard Zvěřina ◽  
Zuzana Balogová ◽  
Oliver Profant ◽  
Jiří Skřivan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Vestibular Schwannoma ◽  
Neurological Complication ◽  
Cranial Nerves ◽  
High Tech ◽  
Csf Leakage ◽  
Nerve Dysfunction ◽  
Grade 3 ◽  
Lower Cranial Nerves

Background. The aim of this study was to analyze complications of vestibular schwannoma (VS) microsurgery.Material and Methods. A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup.Results. In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225) removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III–VI) was observed in 124 cases (45%) immediately after surgery and in 104 cases (33%) on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX–XI) deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%), headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis.Conclusions. Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.

scholarly journals Disease of lower cranial nerves caused by vascular compression

2008 ◽  
Vol 55 (2) ◽  
pp. 27-31 ◽  
Author(s):  
B.D. Antic ◽  
P. Peric ◽  
S.Lj. Stefanovic
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Postoperative Outcome ◽  
Glossopharyngeal Neuralgia ◽  
Statistic Analysis ◽  
Vascular Compression ◽  
Excellent Outcome ◽  
Surgical Options ◽  
Lower Cranial Nerves ◽  
Surgical Option

Between April 1989 and September 2007, 181 patients with disease of lower cranial nerves (DLCN) underwent posterior fossa exploration. As a cause of DLCN, vascular compression (VC) was present in 89 patients with trigeminal neuralgia (TN), in 6 with hemifacial spasm (HFS), in 1 with glossopharyngeal neuralgia, in 1 with Meniere?s disease, and in 5 with multiple DLCN. Depending on intraoperative findings, different surgical options were used: microvascular decompression (MVD), MVD with partial sensory rhizotomy (PSR) or total sensory rhizotomy (TSR). Statistic analysis was made using the Fisher?s exact 2-side test. In patients with TN, excellent outcome was archived in 83 patients and good in 6. Postoperative outcome was better (p = 0.007) in cases with severe VC, but without significant correlation between used surgical option and outcome (p = 0.402). Frequency rate of relapses did not depend on severity of VC (p = 0.502) and used surgical option (p = 0.175). In 6 patients with HFS, excellent outcome was archived in 5 with arterial compression and poor in 1 with venous contact. In patients with Meniere?s disease and glossopharyngeal neuralgia, MVD result with excellent outcome. In 5 patients with multiple DLCN, excellent outcome was archived in 3 and good in 2. MVD is method of choice in surgical treatment of DLCN caused by VC. Overall outcome is better with severity of VC.

scholarly journals The microsurgical anatomy of the glossopharyngeal nerve with respect to the jugular foramen lesions

2004 ◽  
Vol 17 (2) ◽  
pp. 12-21 ◽  
Author(s):  
Mehmet Faik Özveren ◽  
Uđur Türe
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Glossopharyngeal Nerve ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Anatomical Landmarks ◽  
Related Area ◽  
Deep Layers ◽  
Lower Cranial Nerves

Removal of lesions involving the jugular foramen region requires detailed knowledge of the anatomy and anatomical landmarks of the related area, especially the lower cranial nerves. The glossopharyngeal nerve courses along the uppermost part of the jugular foramen and is well hidden in the deep layers of the neck, making this nerve is the most difficult one to identify during surgery. It may be involved in various pathological entities along its course. The glossopharyngeal nerve can also be compromised iatrogenically during the surgical treatment of such lesions. The authors define landmarks that can help identify this nerve during surgery and discuss the types of lesions that may involve each portion of the glossopharyngeal nerve.

scholarly journals Right medium-sized vestibular schwannoma with trigeminal neuralgia post-fractionated radiotherapy

2021 ◽  
Vol 5 (2) ◽  
pp. V10
Author(s):  
Kunal Vakharia ◽  
Anthony L. Mikula ◽  
Ashley M. Nassiri ◽  
Colin L. W. Driscoll ◽  
Michael J. Link
Keyword(s):  
Trigeminal Neuralgia ◽  
Vestibular Schwannoma ◽  
Cranial Nerves ◽  
Motor Branch ◽  
Entry Zone ◽  
Fractionated Radiotherapy ◽  
Root Entry Zone ◽  
Trigeminal Nerve Root ◽  
Microsurgical Resection ◽  
Lower Cranial Nerves

A patient with trigeminal neuralgia secondary to a vestibular schwannoma underwent fractionated radiotherapy without relief of her pain. She was then effectively treated with microsurgical resection of her tumor. Early identification of the lower cranial nerves and the origin of the facial and vestibulocochlear nerves is key to determining the operative corridors for vestibular schwannoma resection. To effectively treat trigeminal neuralgia, the trigeminal nerve root entry zone and motor branch are clearly identified and decompressed. Fractioned radiotherapy does not effectively treat trigeminal neuralgia secondary to vestibular schwannoma compression. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21112

Lower cranial nerves function after surgical treatment of Fisch Class C and D tympanojugular paragangliomas

2013 ◽  
Vol 272 (2) ◽  
pp. 311-319 ◽  
Author(s):  
Andrea Bacciu ◽  
Marimar Medina ◽  
Hassen Ait Mimoune ◽  
Flavia D’Orazio ◽  
Enrico Pasanisi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cranial Nerves ◽  
Class C ◽  
Lower Cranial Nerves

Beyond audiofacial morbidity after vestibular schwannoma surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 367-374 ◽  
Author(s):  
Michael E. Sughrue ◽  
Isaac Yang ◽  
Derick Aranda ◽  
Martin J. Rutkowski ◽  
Shanna Fang ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Size ◽  
English Language ◽  
Cranial Nerves ◽  
Vascular Complications ◽  
Neurological Complications ◽  
Cerebrospinal Fluid Leakage ◽  
Complication Rates ◽  
Translabyrinthine Approach ◽  
Csf Leakage

Object Outcomes following vestibular schwannoma (VS) surgery have been extensively described; however, complication rates reported in the literature vary markedly. In addition, the majority of reports have focused on outcomes related to cranial nerves (CNs) VII and VIII. The objective of this study was to analyze reported morbidity unrelated to CNs VII and VIII following the resection of VS. Methods The authors performed a comprehensive search of the English language literature, identifying and aggregating morbidity and death data from patients who had undergone microsurgical removal of VSs. A subgroup analysis based on surgical approach and tumor size was performed to compare rates of CSF leakage, vascular injury, neurological deficit, and postoperative infection. Results One hundred articles met the inclusion criteria, providing data for 32,870 patients. The overall mortality rate was 0.2% (95% CI 0.1–0.3%). Twenty-two percent of patients (95% CI 21–23%) experienced at least 1 surgically attributable complication unrelated to CNs VII or VIII. Cerebrospinal fluid leakage occurred in 8.5% of patients (95% CI 6.9–10.0%). This rate was markedly increased with the translabyrinthine approach but was not affected by tumor size. Vascular complications, such as ischemic injury or hemorrhage, occurred in 1% of patients (95% CI 0.75–1.2%). Neurological complications occurred in 8.6% of cases (95% CI 7.9–9.3%) and were less likely with the resection of smaller tumors (p < 0.0001) and the use of the translabyrinthine approach (p < 0.0001). Infections occurred in 3.8% of cases (95% CI 3.4–4.3%), and 78% of these infections were meningitis. Conclusions This study provides statistically powerful data for practitioners to advise patients about the published risks of surgery for VS unrelated to compromised CNs VII and VIII.

Endonasal access to lower cranial nerves: From foramina to upper parapharyngeal space

Head & Neck ◽  
2021 ◽  
Author(s):  
Lifeng Li ◽  
Nyall R. London ◽  
Daniel M. Prevedello ◽  
Ricardo L. Carrau
Keyword(s):  
Parapharyngeal Space ◽  
Cranial Nerves ◽  
Lower Cranial Nerves

scholarly journals The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

Endocrines ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 241-250
Author(s):  
Marta Araujo-Castro ◽  
Eider Pascual-Corrales ◽  
Héctor Pian ◽  
Ignacio Ruz-Caracuel ◽  
Alberto Acitores Cancela ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Somatostatin Analogues ◽  
Beneficial Effects ◽  
Key Factor ◽  
Long Acting ◽  
First Time ◽  
Endocrine Complications

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

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