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Conservative facial nerve management in jugular foramen schwannomas
Y Cokkeser1, D E Brackmann, J N Fayad
1Inonu University, ENT Department, Malatya, Turkey.
Objective:
Although transposition of the facial nerve is crucial in infiltrative vascular lesions involving the jugular foramen, the objective was to show that a conservative approach to management of the facial nerve is sufficient with jugular foramen neuromas because of their noninfiltrative, less vascular nature and medial location in the jugular foramen.
Study Design:
Retrospective case review.
Setting:
Tertiary, private, multiphysician, otologic practice.
Patients:
Sixteen patients with jugular foramen schwannoma (18 procedures) treated between January 1975 and October 1995. The 8 male and 8 female patients ranged in age from 13 to 66 years (mean age 47.7 years).
Intervention:
One-stage, total jugular foramen neuroma removal without transposition of the facial nerve, using a variety of surgical approaches.
Main Outcome Measures:
Facial nerve transposition (yes or no), House-Brackmann facial nerve grade, lower cranial nerve status, complications.
Results:
One-stage total tumor removal was accomplished in all the cases. In 13 (72%) of the neuromas, removal was accomplished without facial nerve transposition. Transposition was performed in 2 revision cases in which scar tissue from a previous operation prevented complete control of the carotid artery and safe removal, 2 cases with large tumor extension anteriorly to the petrous apex, and 1 case with extensive involvement of the middle ear. A House-Brackmann facial nerve Grade I or II was obtained in 16 of the 18 procedures, with 1 Grade III and 1 case that remained Grade V, as it was preoperatively.
Conclusions:
One-stage, total tumor removal can be achieved with excellent control of the important vascular structures and without transposition of the facial nerve in a majority of jugular foramen schwannomas.