Intraoperative diagnosis of facial schwannomas: a multicenter summation of clinical experience, preoperative avoidance, and intraoperative management protocol.

Autor:	Lewis D; 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester.; 2Geoffrey Jefferson Brain Research Centre, Manchester.; 3Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester., Hannan CJ; 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester.; 2Geoffrey Jefferson Brain Research Centre, Manchester.; 4Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom., Plitt AR; Departments of5Neurologic Surgery and.; 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Snyder LR; 7University of Manchester., Richardson G; 8School of Medicine, University of Liverpool., King AT; 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester.; 2Geoffrey Jefferson Brain Research Centre, Manchester.; 4Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom., Hammerbeck-Ward C; 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester., Pathmanaban ON; 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester.; 2Geoffrey Jefferson Brain Research Centre, Manchester.; 3Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester., Neff BA; Departments of5Neurologic Surgery and.; 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Driscoll CL; Departments of5Neurologic Surgery and.; 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Van Gompel JJ; Departments of5Neurologic Surgery and.; 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Carlson ML; Departments of5Neurologic Surgery and.; 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Lane JI; Departments of5Neurologic Surgery and.; 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Lloyd SK; 9Department of Otolaryngology, Salford Royal Hospital, Manchester.; 10Department of Otolaryngology, Manchester Royal Infirmary, Manchester.; 11Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester; and., Freeman SR; 9Department of Otolaryngology, Salford Royal Hospital, Manchester.; 10Department of Otolaryngology, Manchester Royal Infirmary, Manchester., Laitt RD; 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom., Abdulla S; 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom., Siripurapu R; 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom., Potter GM; 12Department of Neuroradiology, Manchester Centre for Clinical Neuroscience, Manchester, United Kingdom., Link MJ; Departments of5Neurologic Surgery and.; 6Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota., Rutherford SA; 1Department of Neurosurgery, Manchester Centre for Clinical Neuroscience, Manchester.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2023 Mar 17; Vol. 139 (4), pp. 972-983. Date of Electronic Publication: 2023 Mar 17 (Print Publication: 2023).
DOI:	10.3171/2023.2.JNS222368
Abstrakt:	Objective: Preoperative differentiation of facial nerve schwannoma (FNS) from vestibular schwannoma (VS) can be challenging, and failure to differentiate between these two pathologies can result in potentially avoidable facial nerve injury. This study presents the combined experience of two high-volume centers in the management of intraoperatively diagnosed FNSs. The authors highlight clinical and imaging features that can distinguish FNS from VS and provide an algorithm to help manage intraoperatively diagnosed FNS. Methods: Operative records of 1484 presumed sporadic VS resections between January 2012 and December 2021 were reviewed, and patients with intraoperatively diagnosed FNSs were identified. Clinical data and preoperative imaging were retrospectively reviewed for features suggestive of FNS, and factors associated with good postoperative facial nerve function (House-Brackmann [HB] grade ≤ 2) were identified. A preoperative imaging protocol for suspected VS and recommendations for surgical decision-making following an intraoperative FNS diagnosis were created. Results: Nineteen patients (1.3%) with FNSs were identified. All patients had normal facial motor function preoperatively. In 12 patients (63%), preoperative imaging demonstrated no features suggestive of FNS, with the remainder showing subtle enhancement of the geniculate/labyrinthine facial segment, widening/erosion of the fallopian canal, or multiple tumor nodules in retrospect. Eleven (57.9%) of the 19 patients underwent a retrosigmoid craniotomy, and in the remaining patients, a translabyrinthine (n = 6) or transotic (n = 2) approach was used. Following FNS diagnosis, 6 (32%) of the tumors underwent gross-total resection (GTR) and cable nerve grafting, 6 (32%) underwent subtotal resection (STR) and bony decompression of the meatal facial nerve segment, and 7 (36%) underwent bony decompression only. All patients undergoing subtotal debulking or bony decompression exhibited normal postoperative facial function (HB grade I). At the last clinical follow-up, patients who underwent GTR with a facial nerve graft had HB grade III (3 of 6 patients) or IV facial function. Tumor recurrence/regrowth occurred in 3 patients (16%), all of whom had been treated with either bony decompression or STR. Conclusions: Intraoperative diagnosis of an FNS during a presumed VS resection is rare, but its incidence can be reduced further by maintaining a high index of suspicion and undertaking further imaging in patients with atypical clinical or imaging features. If an intraoperative diagnosis does occur, conservative surgical management with bony decompression of the facial nerve only is recommended, unless there is significant mass effect on surrounding structures.
Databáze:	MEDLINE
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