Preservation of Facial Nerve Function Repaired by Using Fibrin Glue-Coated Collagen Fleece for a Totally Transected Facial Nerve during Vestibular Schwannoma Surgery

Recently, the increasing rates of facial nerve preservation after vestibular schwannoma (VS) surgery have been achieved. However, the management of a partially or completely damaged facial nerve remains an important issue. The authors report a patient who was had a good recovery after a facial nerve reconstruction using fibrin glue-coated collagen fleece for a totally transected facial nerve during VS surgery. And, we verifed the anatomical preservation and functional outcome of the facial nerve with postoperative diffusion tensor (DT) imaging facial nerve tractography, electroneurography (ENoG) and House-Brackmann (HB) grade. DT imaging tractography at the 3rd postoperative day revealed preservation of facial nerve. And facial nerve degeneration ratio was 94.1% at 7th postoperative day ENoG. At postoperative 3 months and 1 year follow-up examination with DT imaging facial nerve tractography and ENoG, good results for facial nerve function were observed.     

硬膜外围膝状神经节面神经管减压术治疗颅底骨折诱发的面瘫

目的探讨颅中窝底硬膜外围膝状神经节面神经管减压术治疗颅底骨折诱发面瘫的效果。方法27例颅底骨折诱发的面瘫患者均接受颅中窝底硬膜外围膝状神经节面神经管减压术治疗。结果无手术并发症发生。按House和Brackmann分级法，术后3个月，神经功能恢复至Ⅶ级14例，Ⅳ级3例，Ⅴ级2例，8例无改变；术后6个月，Ⅰ-Ⅱ级15例，Ⅲ级4例，Ⅳ级2例，6例无改变。结论颅中窝底硬膜外围膝状神经节面神经管减压术可使大部分颅底骨折诱发面瘫患者的临床症状得到改善。     

Hemangioma of the mandibular branch of the trigeminal nerve in the Meckel cave presenting with facial pain and sixth nerve palsy.

In a 25-year-old woman with episodic periorbital-temporal pain who eventually developed a sixth nerve palsy, magnetic resonance imaging revealed a lesion predominantly in the Meckel cave that was found to be a capillary hemangioma arising from the mandibular division of the trigeminal nerve. Hemangiomas of the Meckel cave must be considered in cases of facial pain with a sixth nerve palsy. even if there are no clinical findings of trigeminal neuropathy.     

Hemihypoglossal-facial nerve anastomosis for facial nerve palsy

BACKGROUND AND PURPOSE : Commonly used classic hypoglossal (CN XII) to facial nerve (CN VII) anastomosis has the disadvantage of tongue hemiatrophy. Thus, various attempts have been made to modify this method to reduce the tongue damage. The aim of this report was to present the results of hemihypoglossal-facial nerve anastomosis (HHFA) technique in relation to facial muscles reanimation and hemitongue atrophy. MATERIAL AND METHODS : The first 7 consecutive patients who underwent CN VII anastomosis with half of the CNXII, for which the follow-up period exceeded 12 months, were analysed. During the procedure, CN VII was transected as proximally as possible after drilling the mastoid process. CN XII was separated longitudinally into two parts at a short distance to allow suture of the stumps without any tension. One half of CN XII was transected and sutured to the distal stump of CN VII. Recovery from facial palsy was quantified with the House-Brackmann grading system (HB). Tongue function was assessed according to the scale proposed by Martins. RESULTS : Features of initial reinnervation of facial muscles were visible after 6 months in all 7 patients. All patients achieved satisfactory outcome of CN VII regeneration (HB grade III) until the last control examination (12-27 months after surgery, mean 16). No or minimal tongue atrophy without deviation (grades I-II according to the Martins scale) was found in 4 patients. Mild hemiatrophy with tongue deviation < 30 degrees (grade III) was visible in 3 patients. CONCLUSIONS : In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.     

A pediatric case with peripheral facial nerve palsy caused by a granulomatous lesion associated with cat scratch disease

Background

Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown.

Magnetic resonance imaging in congenital facial palsy

We report magnetic resonance (MR) findings in a patient with congenital unilateral facial palsy and a patient with atypical Moebius syndrome. MR imaging showed a complete deficiency of right facial nerve in the patient with congenital unilateral facial palsy and bilateral, thin proximal facial nerves in the Moebius syndrome patient. Three-dimensional constructive interference in steady state (3D-CISS) MR imaging, especially reconstructions perpendicular to the bilateral internal auditory channel, was very useful when diagnosing patients with facial palsy due to the associated facial nerve abnormalities.     

Neurosurgical treatment of acoustic neuromas without indication for radiosurgery

The aim of this paper is to review the specific problems of the microsurgical management of the acoustic neuromas not suitable for radiosurgical treatment , that is measuring more than 8 cc in volume or 2.5 cm in maximum diameter in the cerebelopontine angle. A total of 18 lesions have been included with a mean volume of 27.4 cc, representing a lesion measuring 3.8 cm in its three main diameters. The mean follow-up has been 48.7 months. There has been no mortality. All lesions were completely excised without recurrences. The anatomic conservation of the facial nerve was achieved in the 66.7% of the cases but the functional recovery (House-Brackmann grades I-II) was reached only in the 27.8%, without any grade I case. As permanent deficit all patients had postoperative cophosis, two had trigeminal hyposthesia with corneal anesthesia and one had a cerebellar deficit. The main conclussion is that the microsurgical radical resection of large acoustic neuromas not suitable for radiosurgical treatment is followed by a high postoperative morbidity mainly related with the facial nerve lesion. Therefore, it seems rationale to design specific strategies directed to reduce and alleviate these permanent deficits.     

Delayed Cranial Nerve Palsy after Microvascular Decompression for Hemifacial Spasm

Objective

Microvascular decompression (MVD) for hemifacial spasm (HFS) is a safe and effective treatment with favorable outcomes. The purpose of this study was to evaluate the incidence of delayed cranirve ( VI, VII, and VIII ) palsy following MVD and its clinical courses.

Methods

Between January 1998 and December 2009, 1354 patients underwent MVD for HFS at our institution. Of them, 100 patients (7.4%) experienced delayed facial palsy (DFP), one developed sixth nerve palsy, and one patient had delayed hearing loss.

Results

DFP occurred between postoperative day number 2 and 23 (average 11 days). Ninety-two patients (92%) completely recovered; however, House-Brackmann grade II facial weakness remained in eight other patients (8%). The time to recovery averaged 64 days (range, 16 days to 9 months). Delayed isolated sixth nerve palsy recovered spontaneously without any medical or surgical treatment after 8 weeks, while delayed hearing loss did not improve.

Conclusion

Delayed cranial nerve (VI, VII, and VIII) palsies can occur following uncomplicated MVD for HFS. DFP is not an unusual complication after MVD, and prognosis is fairly good. Delayed sixth nerve palsy and delayed hearing loss are extremely rare complications after MVD for HFS. We should consider the possibility of development of these complications during the follow up for MVD.     

Facial nerve palsy in posterior fossa arachnoid cysts: report of two cases

Case report Two patients with a posterior fossa arachnoid cyst responsible for isolated facial nerve palsy are reported.Discussion The relationships between the cyst and the facial nerve and between the facial nerve palsy and the size variation of the cyst are discussed and documented by pre- and postoperative magnetic resonance imaging.     

听神经瘤的显微外科治疗和面神经功能保护的探讨

目的 探讨听神经瘤的显微外科手术技巧及保留面神经的技术。 方法 福建医科大学附属第一医院神经外科自2002年8月至2010年12月经枕下乙状窦后（骨瓣成型、锁孔）入路显微手术治疗听神经瘤患者168例,术中在面肌肌电图监测下采取囊内切除与囊壁切除交替进行、双向会合、锐性分离面神经等技术切除肿瘤,并回顾性分析显微手术的技巧和疗效。 结果 肿瘤全切149例(88.69％),部分切除19例(11.31％);面神经解剖学保留146例(86.9％);死亡2例(1.19％)。术后6个月按House Blackmann标准评估面神经功能：Ⅰ、Ⅱ级91例(54.16％),Ⅲ、Ⅳ级52例(30.95％),Ⅴ、Ⅵ级25例(14.89％)。 结论 经枕下乙状窦后（骨瓣成型、锁孔）入路显微手术治疗听神经瘤安全有效;利用术中面肌肌电图监测可以提高面神经解剖保留率;熟练掌握显微手术技巧是全切肿瘤、解剖保留面神经的关键。     

Electrodiagnosis of the cranial nerves

Isolated facial weakness suggests either a contralateral hemispheric lesion or a disease of the facial nerve per se. The presence of sensory symptoms usually indicates a central facial weakness, which characteristically involves the lower part of the face. In contrast, the absence of sensory disturbances suggests a peripheral nerve lesion, some system diseases such as amyotrophic lateral sclerosis, or a stroke sparing the sensory cortex. Sporadic cases of Bell's palsy rank the first in incidence. Although its exact etiology remains unknown, accumulating evidence suggests reactivation of herpes simplex virus type I. A facial palsy that develops in patients with diabetes mellitus tends to show a more severe involvement with substantial denervation. Acoustic neuroma, strategically located at the cerebellopontine angle, may compress the facial nerve. Peripheral facial palsy may herald other symptoms of multiple sclerosis in young adults. Serial electrodiagnostic studies help delineate the course of the illness. The amplitude of the direct response elicited by stimulation of the facial nerve after the fourth to fifth day of onset serves as the best means predicting the eventual outcome of recovery. Blink reflex studies usually show an absent or delayed R1, implicating the central reflex arc, which includes the intrapontine portion of the facial nerve.     

银杏达莫治疗急性特发性面神经麻痹随机对照研究

目的：评价银杏达莫治疗急性特发性面神经麻痹的疗效。方法：62例急性特发性面神经麻痹患者随机分为银杏达莫组31例及对照组31例，分别应用银杏达莫25mL及丹参注射液20mL静脉滴注，每天1次，连续治疗14d，两组均同时使用相同剂量的泼尼松、抗病毒药及维生素B族治疗。治疗后1、3和4周采用House—Brackmann分级法进行疗效评估。结果：治疗后3周银杏达莫组患者痊愈率为48．38％（15／31），改善率为25．81％（8／31），总有效率74．19％；丹参组患者痊愈率为25．81％（8／31），改善率为16，13％（5／31），总有效率41．94％。治疗后4周，银杏达莫组痊愈率为74．19％（23／31），改善率为19．35％（6／31），总有效率93．55％；丹参组痊愈率为45．16％（14／31），改善率为22．58％（7／31），总有效率67．74％。两组间疗效差异有统计学意义（P〈0．05）。结论：银杏达莫治疗急性特发性面神经麻痹的疗效好于丹参。     

Case of pontine infarction causing alternating hemiplegia with ipsilateral abducens nerve palsy and contralateral supranuclear facial nerve palsy]

We report a 73-year-old man with alternating abducent hemiplegia (Raymond syndrome) and contralateral supranuclear facial nerve palsy. On admission, he showed lateral gaze palsy of the right eye, left supranuclear facial nerve palsy, dysarthria and left hemiparesis. Brain MRI showed an infarct that was located in the paramedian and lateral area in the base of the caudal pons on the right side. MRA showed a mild stenosis of the basilar artery. Hemiplegia and supranuclear facial nerve palsy were considered to be caused by the involvement of corticospinal tract and corticobulbar tract that run at the ventromedial area of the pons. Abducens nerve palsy was considered to be caused by the involvement of infranuclear abducens nerve fibers. There has been one previously reported case of Raymond syndrome in which MRI determined the precise location of the lesion. In this case, a small hematoma was found at the ventral and medial pontomedullary junction, whereas the infarct in our case was located in the pontine base. We considered that documentation of our case was an important contribution to determine the pathogenesis of supranuclear facial nerve palsy due to caudal pontine lesions.     

30例Ramsay-Hunt综合征临床分析

目的探讨Ramsay-Hunt综合征的药物治疗以及影响预后的因素。方法回顾性分析2015-01—2019-01在我科诊治的30例Ramsay-Hunt综合征患者的临床资料,面神经功能评估采用House-Brackman分级。结果所有患者于发病1周内就诊,可见耳甲腔或外耳道疱疹,同侧面瘫均Ⅲ级及以上,其中伴声嘶2例,伴眩晕5例,伴面部疱疹4例。经过2周药物治疗后,2例伴声嘶患者面神经功能为Ⅲ级,1例治疗后2周复发,其余患者面神经功能均恢复正常。结论Ramsay-Hunt综合征早期药物治疗面瘫恢复较好,但累及迷走神经者预后较差。     

Pathological laughter in a patient with trigeminal neurinoma

We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up.     

经乙状窦后-内听道入路微创手术治疗听神经瘤

目的探讨听神经瘤微创显微手术切除听神经瘤的手术方法和技巧,以提高肿瘤的全切除率和面神经的功能保护率。 方法回顾性分析陆军总医院附属八一脑科医院自2000年1月至2017年12月应用多模态技术辅助经枕下乙状窦后-内听道入路微创手术治疗的887例听神经瘤患者的临床资料。术后3个月常规复查增强MRI明确肿瘤切除程度,评估面神经功能。 结果肿瘤全切841例,全切除率为94.8%。术中面神经解剖保留832例,面神经解剖保留率为93.7%;解剖未能保留的55例,其中16例术中行面神经端-端吻合,另有3例术后行面神经移植。肿瘤切除3个月后复查,面神经功能Ⅰ~Ⅱ级695例(78.4%）,Ⅲ~Ⅳ级176例(19.8%）,Ⅴ级16例(1.8%）。 结论听神经瘤微创显微手术有助于提高肿瘤切除的安全性和手术疗效,熟练掌握显微手术技巧是提高肿瘤全切除、面神经解剖和功能保护率的关键。     

Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography

Objective

Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve.

Methods

We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system.

Results

Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year.

Conclusion

This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation.     

Combined peripheral facial and abducens nerve palsy caused by caudal tegmental pontine infarction

Isolated peripheral facial and abducens nerve palsy could theoretically be caused by a caudal pontine infarction, but as far as we know, there has been no published case history which has demonstrated this point. We describe the cases of two hypertensive patients who showed combined peripheral facial and abducens nerve palsy without other neurologic symptoms or signs. Other than hypertension, there was no identifiable etiology. Magnetic resonance imaging demonstrated compatible isolated ipsilateral ischemic infarction of the caudal tegmental pons. The present cases indicate that a well-placed small pontine infarction can cause isolated peripheral facial and abducens nerve palsy.