Prognostic factors of facial nerve function after vestibular schwannoma removal via translabyrinthine approach

Background: Prediction of facial function is a major concern when proposing surgery for patients with vestibular schwannoma (VS).

Aims/objectives: To evaluate postoperative facial function of patients who underwent operation of VS via a translabyrinthine approach (TL), and to analyze factors that influence facial functions.

Material and methods: A total of 91 VS patients, who were operated via a TL approach, between March 1997 and December 2016, were analyzed. Demographics, tumor-related factors, and operative findings were collected. Facial function was assessed according to the House-Brackmann (HB) grading system before surgery, immediately after surgery, and 1-, 3-, 6-months, and 1 year after surgery.

Results: In cases of patients that had a tumor that extended to the CPA, an unsatisfactory facial outcome was noted in 12 (30.0%) patients. FN outcomes after tumor removal depend on tumor size (p?=?.040). Among FN-related factors, only the FN recovery timing was correlated with facial outcomes (p?=?.030). Univariable and multivariable analysis revealed that tumor size and the timing of FN recovery were significant as favorable prognostic factors for good facial outcomes.

Conclusions and significance: Tumor size and the FN recovery timing are significant prognostic factors of facial outcome in VS patients who underwent operations via a TL approach.     

Intraparotid facial nerve schwannoma: a 17-year,single-institution experience of diagnosis and management

Background: Intraparotid facial nerve schwannoma (IFNS) is rare and its definite preoperative diagnosis is challenging.

Objective: To improve available knowledge regarding the diagnosis of IFNS and to suggest an appropriate treatment plan.

Material and methods: We retrospectively analyzed medical records of IFNS patients at our hospital. Inclusion criteria were surgery (from January 2000, to December 2016) for a parotid mass, pathologically diagnosed as a schwannoma.

Results: The study included 42 eligible patients who had undergone tumor resection from 5977 parotid tumor patients. Mostly presented hard-textured (18/39) or medium-textured (15/39), with limited mobility (21/39) mass (three tumors were not palpable). Their facial nerve function outcomes were House–Brackmann Grade I (n?=?14), Grade II (n?=?7), Grade III (n?=?11), Grade IV (n?=?5), Grade V (n?=?3), and Grade VI (n?=?2). Significant differences were noted in results based on different surgical methods used (p?=?.000) and tumor involvement (p?=?.002).

Conclusions and significance: A hard-textured tumor with limited mobility mass in the parotid gland should prompt the diagnosis of a schwannoma. Tumors involving main trunk usually lead to unsatisfactory facial nerve outcomes. Facial nerve preservation should always be essential, and stripping surgery or intracapsular enucleation could be the preferred surgical methods of choice.     

Outcome analysis of 40 cases of vestibular schwannoma: A comparison of sitting and Park bench surgical position

The present study retrospectively reviews our experience in 40 cases of vestibular schwannoma, operated between the years 1995 and 2002. All the patients underwent tumour resection either in sitting or in the Park bench position via the suboccipital retromastoid route. The position of the patient was selected arbitrarily. Precordial Doppler echocardiography was used to monitor air embolism. Operative results, including the size of the tumour, completeness of resection, anatomical and functional preservation of the facial nerve, operative complications and mortality were analysed and compared in these two operative positions. There was no statistically significant difference in terms of surgical results between these two groups.      

胰腺神经鞘瘤临床诊治分析

目的：探讨胰腺神经鞘瘤的临床特点和诊治方法。方法总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁（范围17～89岁）,其中女性40例（56％）。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6．1 cm （1～20 cm）。肿瘤位于胰头部29例（40％）、胰体／尾部32例（44％）,沟突部6例（8％）。肿瘤表现为实性肿物27例（38％）、囊性28例（39％）、囊实性10例（14％）。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例（7％）患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[（13．8±6．2）cm vs （5．6±4．1）cm,P ＝0．0004）]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。     

Cellular schwannoma of the abducens nerve: Case report and review of the literature

Schwannomas of the abducens nerve are extremely uncommon tumors. Here, we report the case of a 26-year-old woman who presented with a 6th nerve palsy and was found to have a large tumor at the right side of her pons. Neuropathologic exam revealed a cellular schwannoma with a high proliferation index. The case is presented in its clinical, neurosurgical and neuropathologic aspects and the literature on 6th nerve schwannomas is reviewed.     

Determining Benchmarks in Hearing Preservation Surgery for Vestibular Schwannoma

Objectives The objectives of this study were to determine minimal benchmarks of success in vestibular schwannoma hearing preservation surgery, wherein the likelihood of having preserved hearing in a single patient is at least as likely as having created a poor facial nerve outcome for a single patient.Design This is a statistical analysis of published literature.Setting Academic Tertiary Medical Center.Main Outcome Measures Based on published natural history data, the number needed to treat (NNT) equation was used to calculate the minimally acceptable hearing preservation rates within various hearing classification schemes.Results Given good facial nerve outcome rates of 85, 90, and 95%, the corresponding hearing preservation rates at 4.7 years that are likely to preserve classes A and B hearing (American Academy of Otolaryngology-Head and Neck Surgery classification) in a single patient as to cause a poor facial nerve outcome are 70, 65, and 60%, respectively. If surgery is limited exclusively to intracanalicular tumors, these rates drop to 62, 57, and 52%, respectively. If the word recognition scoring classification is used, required hearing preservation rates are higher.Conclusion It is possible to use the NNT equation alongside projected facial nerve outcomes to estimate benchmarks of minimally acceptable hearing preservation rates.