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3.
World Neurosurg ; 136: e262-e269, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31904436

RESUMO

BACKGROUND: Facial paralysis secondary to a complete and irreversible anatomic or functional lesion of the facial nerve (FN) causes severe functional and psychological disorders for the patient. A large number of surgical techniques have therefore been developed for FN repair. Our objective was to propose a surgical FN reanimation protocol for patients with irreversible anatomic or functional postsurgical injury of the FN in the cerebellopontine angle after vestibular schwannoma resection. METHODS: The clinical study included a total of 16 patients undergoing side-to-end hypoglossal-facial neurorrhaphy (SEHFN) since 2010, in which the FN injury was always secondary to vestibular schwannoma surgery in the cerebellopontine angle using a retrosigmoid approach. All patients had complete clinical facial paralysis at the time of the SEHFN. The anatomic study was conducted using 3 heads and necks (6 SEHFN). RESULTS: Twelve months after surgery, FN function assessment with the House and Brackmann scale showed 2 patients with grade II, 13 patients with grade III, and only 1 patient with grade IV, and after 2 years, 4 patients had grade II, 11 patients had grade III, and 1 patient had grade IV. The average length of the anastomotic translocation portion of the FN in the anatomic study was 34.76 mm. CONCLUSIONS: Side-to-end epineural suture of the FN, mobilizing its mastoid segment on the hypoglossal nerve with partial section of the dorsal aspect of the hypoglossal nerve, is a safe anatomic surgical technique for FN reanimation with outstanding clinical results.


Assuntos
Traumatismos do Nervo Facial/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Nervo Hipoglosso/cirurgia , Transferência de Nervo/métodos , Neuroma Acústico/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
4.
Ann Otol Rhinol Laryngol ; 129(3): 230-237, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31635473

RESUMO

OBJECTIVE: Characterize current perspectives in the surgical management of vestibular schwannoma (VS) to guide otolaryngologists in understanding United States practice patterns. METHODS: A retrospective analysis of ACS-NSQIP database was performed to abstract all patients from 2008 to 2016 who underwent VS resection using ICD-9/10 codes 225.1 and D33.3, respectively. The specific surgical approach employed was identified via CPT codes 61520, 61526/61596, and 61591, which represent retrosigmoid (RS), translabyrinthine (TL) and middle cranial fossa (MCF) approaches, respectively. Analyzed outcomes include general surgical complications, total length of stay, and reoperation. RESULTS: A total of 1671 VS cases were identified, 1266 (75.7%) were RS, 292 (17.5%) were TL, and 114 (6.8%) were MCF. The annual number of cases increased over the study period from 15 to 375, which is chiefly attributed to increased institutional participation in ACS-NSQIP. Perioperative variables including BMI (P < .001), ASA class (P = .004), ethnicity (P = .008), operative time (P < .001), and reoperation (P < .001) were found to be statistically significant between cohorts. Increased utilization of RS approach was consistent over the entire study period, with significantly more RS performed than either TL or MCF. Finally, a statistically significant difference with respect to general surgical complication rates was not noted between surgical approaches. CONCLUSIONS: There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.


Assuntos
Neuroma Acústico/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Grupos de Populações Continentais/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neurocirurgiões/estatística & dados numéricos , Duração da Cirurgia , Otorrinolaringologistas/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
5.
PLoS One ; 14(12): e0226607, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31869358

RESUMO

PURPOSE: The aim of this study was to analyze the utility of various preoperative electrophysiological tests of the facial nerve CNVII in predicting CNVII function after vestibular schwannoma surgery. METHODS: This retrospective study included 176 patients who had preoperative facial nerve electroneurography and electrically evoked blink reflex testing. We defined the following variables: axonal degeneration of CNVII (AD-CNVII), trigeminal nerve damage (D-CNV), disturbances in the short-latency pathway of the blink reflex (D-BR), and any changes in electrophysiological test results (A-EMG). RESULTS: AD-CNVII, D-CNV, D-BR, and A-EMG were noted in 24%, 10%, 64%, and 71% of the patients, respectively. Negative D-CNV correlated with good CNVII function in early (p = 0.005) and long-term follow-up (p = 0.003) but was not an independent prognostic factor for postoperative facial muscles function. D-CNV appeared to be closely related to tumor size. D-BR was related to tumor size and had no predictive value. AD-CNVII (amplitude reduction of 50% or more compared to the healthy side) was an independent factor associated with increased risk of facial muscles weakness (p = 0.015 and p = 0.031 for early and late outcomes, respectively). CONCLUSIONS: Further studies are needed to establish which tests and cut-off values are the most useful for predicting post-surgical facial nerve function.


Assuntos
Nervo Facial/fisiopatologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Eletrodiagnóstico/métodos , Fenômenos Eletrofisiológicos , Nervo Facial/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Adulto Jovem
7.
World Neurosurg ; 132: e223-e227, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493598

RESUMO

OBJECTIVE: This study focused on the changes in the internal acoustic canal (IAC) caused by vestibular schwannomas (VSs) and their prognostic significance for postoperative hearing outcome. METHODS: A total of 125 consecutive cases of VS were included. We used a neuronavigation software to perform the following measurements on both the tumor side and healthy side: volume of the IAC (VIAC), maximal diameter of the IAC (DIAC), and length of the IAC (LIAC). A statistical analysis was realized using Spearman correlation to test the correlation of the morphometric measure of the IAC and postoperative hearing. Multivariate analysis was performed to test the impact of measurements of the IAC and preoperative hearing on postoperative hearing. RESULTS: The mean VIAC on the tumor side and on the healthy side was 0.271 and 0.169 cm3, respectively. The mean DIAC was 9.438 mm on the tumor side and 7.034 mm contralateral. The correlations tests showed significant correlations of both postoperative hearing deficit and degree of hearing loss with 1) VIAC on the tumor side, 2) difference between VIAC on the tumor side and healthy side, 3) DIAC on the tumor side, and 4) difference between the DIAC on the tumor side and healthy side. The multivariate analysis showed significant impact of the DIAC (P = 0.01) and preoperative hearing status (P = 0.02) on postoperative hearing. CONCLUSIONS: Enlargement of the VIAC and DIAC are negative prognostic factors for hearing preservation. Reasons may be long-standing compression of the auditory nerve and an increased vulnerability of the inner ear structures during the drilling of the IAC.


Assuntos
Orelha Interna/patologia , Perda Auditiva/etiologia , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Adulto , Idoso , Orelha Interna/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuronavegação , Prognóstico , Adulto Jovem
8.
World Neurosurg ; 132: e228-e234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493607

RESUMO

PURPOSE: To search for texture features of routine magnetic resonance imaging to predict tumor volume reduction and transient versus permanent tumor progression of vestibular schwannomas treated by Gamma Knife stereotactic radiosurgery. MATERIALS AND METHODS: Included were 23 patients with vestibular schwannomas treated in our center and followed over a period of 23.7-80.3 months (mean 42.7). Magnetic resonance imaging was performed on a 3-Tesla scanner and included T1-weighted images with and without contrast enhancement, T2-weighted, and fluid-attenuated inversion recovery images. Volumetric results were followed longitudinally over time and correlated to texture features as mean, minimum, maximum, standard deviation, skewness, and kurtosis of normalized signals taken from regions of interest covering the total tumor volume. RESULTS: In total, 14 tumors showed early progression during the first 5-18 months (2 cases permanent, 12 cases transient), whereas 9 tumors regressed immediately after SRS. Kurtosis of T2-weighted image intensity values turned out to predict progression best with a sensitivity and specificity of 71% and 78%. From all texture feature parameters, only the minimum of the normalized T2-weighted image intensity values correlated significantly to the final reduction of tumor volume per month (correlation coefficient = -0.634, P < 0.05, corrected for false discovery rate). CONCLUSIONS: Texture feature analysis helps to predict permanent versus transient enlargement and final volume reduction of schwannomas after SRS. Thus, alternative treatment strategies might be considered, mainly in large tumors, where further clinical deterioration cannot be excluded. To confirm these results, a prospective study including more cases and a longer follow-up period is necessary.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Neuroimagem/métodos , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/cirurgia , Adolescente , Adulto , Idoso , Criança , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Radiocirurgia , Adulto Jovem
9.
World Neurosurg ; 132: 375-376, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493615

RESUMO

Facial nerve identification and preservation is a critical step in the resection of vestibular schwannoma. The use of intraoperative neurostimulation to positively identify the facial nerve along its entire course is essential to prevent injury. To our knowledge, this is the first reported case of a bifid facial nerve with a dual origin at the brainstem, which we observed during resection of vestibular schwannoma via the translabyrinthine approach. Both roots were visualized to join as one facial nerve trunk outside the brainstem in the cisternal segment of the facial nerve, and both trunks demonstrated positive signal with neurostimulation. This case highlights an important anatomic variation and also the importance of correct identification of facial nerve anatomy during resection of vestibular schwannoma and other pathologies within the cerebellopontine angle.


Assuntos
Nervo Facial/anormalidades , Nervo Facial/patologia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos , Ângulo Cerebelopontino/patologia , Orelha Interna/cirurgia , Estimulação Elétrica , Humanos , Masculino , Pessoa de Meia-Idade
12.
World Neurosurg ; 132: 397, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541758

RESUMO

A 50-year-old man with a history of left-sided retrosigmoid craniotomy for vestibular schwannoma (VS) resection 19 years prior presented with severe headache and left cerebellopontine angle subarachnoid hemorrhage (SAH). Digital subtraction angiography demonstrated a dissected, nonfunctional left posterior inferior cerebellar artery with direct fistulization at the left transverse sinus (Video 1). The lesion was treated with endovascular Onyx embolization. The patient recovered without neurologic deficit. Five additional cases of new dural arteriovenous fistula arising after VS resection have been described; we report the first such case presenting with SAH, suggesting that postoperative magnetic resonance angiography may be of value in long-term VS follow-up imaging protocols.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Artérias Cerebrais/lesões , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/terapia , Hemorragia Subaracnóidea/terapia , Malformações Vasculares do Sistema Nervoso Central/etiologia , Ângulo Cerebelopontino , Cerebelo/irrigação sanguínea , Embolização Terapêutica , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Ruptura , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento
13.
World Neurosurg ; 132: e34-e39, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520763

RESUMO

OBJECTIVE: Vestibular schwannomas (VSs) can either be solid or contain variable amounts of cystic components. It has been established that gamma knife radiosurgery (GKRS) is an effective treatment modality for solid VSs. However, in the case of cystic VS, given the somewhat unpredictable growth of the cystic portion of these tumors, microsurgery has often been preferred to GKRS in the management of cystic VS. However, to date, a relative paucity of data evaluating the outcomes after GKRS for cystic VS has been available. In the present study, we reviewed our experience treating cystic VSs with GKRS and evaluated the results. METHODS: The data from patients with a diagnosis of cystic VS who had undergone GKRS from 1999 to 2018 were analyzed. Only those patients who had undergone GKRS as the initial treatment of cystic VSs were included in the present study. Patients who had undergone previous surgical treatment were excluded. The cystic VSs were divided into intratumoral and peritumoral cysts. RESULTS: A total of 24 patients were enrolled in the present study. The mean age was 60.8 ± 2.4 years (range, 38-82 years). The mean follow-up period was 55.8 ± 8.1 months (range, 8-145 months). Of the 24 patients, 11 were men. The control rate after GKRS for cystic VSs was 75%. The 5-year progression-free rate was 70%. Six patients had presented with an increasing lesion size after GKS. Of these 6 patients, 2 underwent surgical treatment and 1 underwent repeat GKRS. No statistically significant differences were found between the control rate and cystic type (P = 0.093). CONCLUSION: The results from the present study have demonstrated that GKRS is an effective treatment modality for cystic VSs.


Assuntos
Neuroma Acústico/cirurgia , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/patologia , Cistos/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
14.
World Neurosurg ; 132: e28-e33, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521756

RESUMO

OBJECTIVE: To evaluate whether use of partial nondepolarizing neuromuscular blocking agents, at a train-of-four level 1, compromise facial nerve monitoring during vestibular schwannoma (VS) resection. METHODS: Sixty consecutive patients undergoing VS resection were enrolled into a partial peripheral neuromuscular blockade group or free of neuromuscular blockade group. Stimulation threshold to elicit an electromyographic response amplitude of at least 100 µV was recorded at the proximal and distal facial nerve after VS removal. The proximal-to-distal ratio of amplitude of the orbicularis oculi and oris muscles was calculated. RESULTS: All patients successfully passed the electromyography monitoring test. Mean electrical stimulation thresholds were higher in the peripheral neuromuscular blockade group than in the free of neuromuscular blockade group (0.12 mA vs. 0.06 mA at proximal site, P = 0.001; 0.08 mA vs. 0.03 mA at distal site, P = 0.0002). The differences in median proximal-to-distal amplitude ratios were not statistically significant in both groups. There was a trend toward more patients needing phenylephrine. Recovery profiles were comparable in the 2 groups. CONCLUSIONS: Although mean stimulation threshold to elicit a response amplitude was higher in the peripheral neuromuscular blockade group than in the free of neuromuscular blockade group at the proximal site, the stimulation thresholds in both groups were sufficient for facial nerve monitoring in VS surgery, indicating no clinical difference in both groups.


Assuntos
Eletromiografia , Nervo Facial , Monitorização Neurofisiológica Intraoperatória/métodos , Neuroma Acústico/cirurgia , Bloqueio Neuromuscular , Adulto , Período de Recuperação da Anestesia , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/efeitos dos fármacos , Músculos Oculomotores/cirurgia , Fenilefrina/farmacologia , Simpatomiméticos/farmacologia
17.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 179-187, jul.-ago. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183584

RESUMO

Objective: The aims of our study were to evaluate tumour response in a series of patients with vestibular schwannoma (VS) treated with linear accelerator stereotactic radiosurgery (LINAC-RS), to describe the complications and to analyze the variables associated with the response to treatment. Material and methods: This retrospective descriptive study included 64 patients treated from 2010 to 2016 with a minimum follow-up of one year, excluding patients with neurofibromatosis. Clinical-radiological parameters were evaluated. The treatment was performed using LINAC-RS. The prescribed dose was 12Gy at 90% isodose. Results: The mean age at treatment was 53 years, 56% were women. Ninety-eight percent of the patients had hearing loss, 71% with grade III according to the Gardner-Robertson Classification. The mean volume at treatment was 2.92cc and the mean follow-up, 40.95 months. The overall therapeutic success was 90%, reaching 100% at 12 and 24 months, and 86% after 36 months of follow-up. The radiological result was significantly related to the initial tumour volume (p<0.037). In 20 patients there was evidence of transient tumour growth compatible with pseudoprogression. Acute complications were present in 37.5%, and transitory complications in 50%. Chronic complications were found in 20%, with 84% being permanent. The rate of acute complications was lower in patients with regression (p<0.016). Chronic complications were more frequent in the 41-60 year old age group (p<0.040). Conclusions: In our study, the overall tumour control was in accordance with other published series. The radiological result significantly related to the tumour volume at the commencement of treatment. The rate of acute complications was lower in patients with regression


Objetivo: Los objetivos del estudio fueron evaluar la respuesta tumoral en una serie de pacientes con schwannoma vestibular (SV) tratados con radiocirugía (RC) mediante acelerador lineal de electrones (LINAC), describir las complicaciones y analizar las variables relacionadas con la respuesta al tratamiento. Material y métodos: Estudio descriptivo retrospectivo de 64 pacientes tratados entre 2010-2016 con seguimiento mínimo de un año, excluyendo pacientes con neurofibromatosis. Se evaluaron parámetros clínico-radiológicos. El tratamiento se realizó mediante RC-LINAC. La dosis prescrita fue de 12Gy al 90% de isodosis. Resultados: La edad media al tratamiento fue de 53 años, 56% mujeres. El 98% de los pacientes presentaban hipoacusia, el 71% grado iii según la clasificación Gardner-Robertson. El volumen medio al tratamiento fue de 2,92cc, y la media de seguimiento 40,95 meses. El éxito terapéutico global fue del 90% siendo del 100% a los 12 y 24 meses y del 86% a partir de los 36 meses de seguimiento. El resultado radiológico se relacionaba con el volumen tumoral inicial (p<0,037). En 20 pacientes se evidenció un crecimiento tumoral transitorio compatible con seudoprogresión. El 37,5% tuvieron complicaciones agudas siendo transitorias el 50%. Se recogieron complicaciones crónicas en el 20%, siendo permanentes en el 84%. La tasa de complicaciones agudas era menor en pacientes con regresión (p<0,016). Las complicaciones crónicas fueron más frecuentes en el grupo de 41-60 años (p<0,040). Conclusiones: En nuestra serie, el control tumoral global obtenido es acorde con otras series publicadas. El resultado radiológico estaba relacionado con el volumen tumoral inicial al tratamiento. La tasa de complicaciones agudas fue menor en pacientes con regresión


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neuroma Acústico/radioterapia , Neuroma Acústico/cirurgia , Radiocirurgia/métodos , Aceleradores de Partículas , Estudos Retrospectivos , Perda Auditiva/radioterapia , Perda Auditiva/cirurgia
18.
J Laryngol Otol ; 133(7): 560-565, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31267888

RESUMO

OBJECTIVE: To examine when cochlear fibrosis occurs following a translabyrinthine approach for vestibular schwannoma resection, and to determine the safest time window for potential cochlear implantation in cases with a preserved cochlear nerve. METHODS: This study retrospectively reviewed the post-operative magnetic resonance imaging scans of patients undergoing a translabyrinthine approach for vestibular schwannoma resection, assessing the fluid signal within the cochlea. Cochleae were graded based on the Isaacson et al. system (from grade 0 - no obstruction, to grade 4 - complete obliteration). RESULTS: Thirty-nine patients fulfilled the inclusion criteria. The cochleae showed no evidence of obliteration in: 75 per cent of patients at six months, 38.5 per cent at one year and 27 per cent beyond one year. Most changes happened between 6 and 12 months after vestibular schwannoma resection, with cases of an unobstructed cochlear decreasing dramatically, from 75 per cent to 38.5 per cent, within this time. CONCLUSION: The progress of cochlear obliteration that occurred between 6 and 12 months following vestibular schwannoma resection indicates that the first 6 months provides a safer time window for cochlear patency.


Assuntos
Doenças Cocleares/diagnóstico por imagem , Doenças Cocleares/patologia , Neuroma Acústico/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Adulto , Idoso , Doenças Cocleares/etiologia , Implante Coclear , Feminino , Fibrose , Testes Auditivos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
19.
PLoS One ; 14(7): e0217253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276518

RESUMO

OBJECTIVE: Meningitis after microsurgery for vestibular schwannoma (VS) is a severe complication that results in high morbidity. However, few studies have focused on meningitis after VS surgery. The purpose of this study was to identify the risk factors for meningitis after VS surgery. METHODS: We performed a retrospective analysis of all VS patients who underwent microsurgery and survived for at least 7 days after surgery, between 1 June 2015 and 30 November 2018 at West China Hospital of Sichuan University. Univariate and multivariate analyses were performed to identify the risk factors for postoperative meningitis (POM). RESULTS: We enrolled 410 patients, 27 of whom had POM. Through univariate analysis, the factors of hydrocephalus (p = 0.018), Koos grade IV (p = 0.04), operative duration > 3 hours (p = 0.03) and intraoperative bleeding volume ≥400 ml (p = 0. 02) were significantly correlated with POM. The multivariate analysis showed that Koos grade IV (p = 0.04; OR = 3.19; 95% CI 1.032-3.190), operation duration > 3 hours (p = 0.03; OR = 7.927; 95% CI 1.043-60.265), and intraoperative bleeding volume ≥ 400 ml (p = 0.02; OR = 2.551; 95% CI 1.112-5.850) were the independent influencing factors of POM. CONCLUSIONS: Koos grade IV, operation duration > 3 hours, and intraoperative blood loss ≥ 400 ml were identified as independent risk factors for POM after microsurgery for VS. POM also caused a prolonged hospital stay.


Assuntos
Perda Sanguínea Cirúrgica , Imagem por Ressonância Magnética , Meningite , Microcirurgia/efeitos adversos , Neuroma Acústico , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Meningite/diagnóstico por imagem , Meningite/epidemiologia , Meningite/etiologia , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/epidemiologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
20.
World Neurosurg ; 130: 410-414, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349082

RESUMO

BACKGROUND: Hemifacial spasm (HFS), one of the most common hyperactive cranial rhizopathies, is a disorder characterized by spontaneous, intermittent, and repetitive contraction of unilateral facial muscle. The most common cause of HFS is a mechanical compression of the facial nerve at the root exit zone (REZ) by blood vessels located in the brainstem. The incidence of cerebellopontine angle (CPA) tumor-induced HFS ranges from 0.3%-2.5% of all patients with HFS, and the incidence of epidermoid cyst among such tumors is extremely rare (0.2% to 0.25%). We present a patient manifesting HFS induced by a small epidermoid cyst who underwent Gamma Knife surgery (GKS) for ipsilateral vestibular schwannoma (VS) more than 10 years ago. CLINICAL DESCRIPTION: A 59-year-old female was admitted to our hospital with HFS. Ten years before admission, the patient underwent GKS for ipsilateral VS. Enhanced brain magnetic resonance imaging demonstrated that the volume of VS was not increased. Also, no definitive mechanical compression of the facial nerve REZ by blood vessels was detected. We concluded that HFS was secondary to the VS treatment by GKS and decided to operate to remove the tumor and identify REZ. A standardized lateral suboccipital retrosigmoid approach was performed. The cochlear nerve was encased by a tumor mass, and the posterior inferior cerebellar artery (PICA) was displaced by the mass. During tumor excision, we ensured that the VS and displaced PICA did not directly compress the REZ. Interestingly, an unexpected lesion was found with a yellowish viscous mass located between the sixth nerve and ventral side of the seventh nerve REZ. After the tumor removal, a small piece of Teflon was inserted between the PICA and REZ of the facial nerve. Postoperatively, the patient experienced no HFS or facial nerve dysfunction. Histopathologic examination of the lesion revealed an epidermoid cyst. CONCLUSIONS: We should consider various possibilities for the cause of HFS and review brain imaging meticulously if patients were treated for CPA tumor with GKS a long time ago and the delayed HFS occurred without changes in tumor volume. HFS induced by epidermoid cyst is rare. Therefore it is critical for the neurosurgeon to ensure the absence of any abnormal contact with the REZ of the facial nerve during surgery for HFS induced by CPA tumors.


Assuntos
Cisto Epidérmico/complicações , Espasmo Hemifacial/etiologia , Neuroma Acústico/diagnóstico , Doenças do Nervo Vestibulococlear/complicações , Diagnóstico Diferencial , Erros de Diagnóstico , Cisto Epidérmico/radioterapia , Feminino , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/cirurgia , Humanos , Pessoa de Meia-Idade , Neuroma Acústico/cirurgia , Radiocirurgia , Retratamento , Resultado do Tratamento , Doenças do Nervo Vestibulococlear/radioterapia
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