Cirugía del schwannoma vestibular. Factores predisponentes y predictores de parálisis facial.

Susana MARCOS-ALONSO, Rosana VILLAOSLADA-FUENTES, Ángel MUÑOZ-HERRERA, Ángel BATUECAS-CALETRÍO, Santiago SANTA-CRUZ-RUÍZ, Ramón Antonio MARTÍNEZ-CARRANZA

Resumen


Introducción y objetivo: La parálisis facial es una de las posibles complicaciones que pueden aparecer tras la cirugía del schwannoma vestibular. Nuestro objetivo es identificar los posibles factores perioperatorios que puedan predecir la aparición de esta complicación. Método: Se lleva a cabo un estudio retrospectivo en 291 pacientes diagnosticados de schwannoma vestibular entre 1995 y 2017 en el servicio de Otorrinolaringología y Cirugía Cervicofacial del Hospital Clínico Universitario de Salamanca, analizándose diferentes datos pre y postoperatorias de los pacientes, así como hallazgos radiológicos y quirúrgicos. Resultados: Del total de pacientes operados y que completan el seguimiento (N=140), no presentan parálisis facial (PF) a los 7 días (grado I) un 44.4%, 6.8% son grado II, 3.8% grado III, 8.3% grado IV, 10.5% grado V, 26.3% grado VI. A los 6 meses un 51.9% tiene grado I, un 11.1% presenta un grado II, 10.4% un grado III, 7.4% un grado IV, 8.1% un grado V y 11.1% un grado VI. Es decir, tras 6 meses desde la operación, presenta PF (grado II) un 48.1 % de pacientes y presentan una buena función del nervio facial (grados I-III [15]) 70,4 % pacientes. Las variables significativas que asociamos a la PF son grados de tumor III-IV, cirugía retrosigmoidea, exéresis completa, estudio electrofisiológico del nervio facial (EEF) alterado, no preservación de la audición y videonistagmografía (VNG) patológica. Discusión y conclusiones: el factor más predictivo, en cuanto a la aparición de PF, es el tamaño del tumor siendo otro factor predictivo importante el tipo de cirugía que se va a realizar. Otros factores son la totalidad de la extirpación, un registro anómalo (axonotmesis o neurotmesis) en el EEF y el déficit canalicular determinada por VNG entre 76-100% y entre 25-75%.

Palabras clave


schwannoma vestibular; neurinoma del acústico; cirugía; parálisis facial

Texto completo:

PDF

Referencias


Arts HA, Telian SA, El-Kashlan H, Thompson BG. Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: results using the middle cranial fossa approach. Otol Neurotol. 2006; 27(2): 234-41.

https://doi.org/10.1097/01.mao.0000185153.54457.16

PMid:16436995

Bai-Yun L, Yong-ji T, Wen L, Shu-ling L, Hui Q, Jun Ting Z, Gui-Jun J. Intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation for preservation of facial nerve function in patients with large acoustic neuroma. Chin Med J. 2007; 120(4): 323-5.

https://doi.org/10.1097/00029330-200702020-00013

Benett M, Haynet DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin North Am. 2007; 40(3): 589-609.

https://doi.org/10.1016/j.otc.2007.03.007

PMid:17544697

Bernat I, Grayeli AB, Esquia G, Zhang Z, Kalamarides M, Sterkers O. Intraoperative electromyography and surgical observations as predictive factors of facial nerve outcome in vestibular schwannoma surgery. Otol Neurotol. 2010; 31 (2): 306-12.

https://doi.org/10.1097/MAO.0b013e3181be6228

PMid:19816232

Bloch O, Sughrue ME, Kaur R, Kane AJ, Rutkowski MJ, Kaur G, Yang I, Pitts LH, Parsa AT. Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma. J Neuroncol. 2011; 102(2): 281-6.

https://doi.org/10.1007/s11060-010-0315-5

PMid:20694574 PMCid:PMC3052445

Brackmann DE, Green JD. Translabyrinthine approach for acoustic tumor removal. Otolaryngo Clin North Am. 1992; 25(2): 311-29.

PMid:1630831

Charabi S, Thomsen J, Tos M, Charabi B, Mantoni M, Borgesen SE. Acoustic neuroma: vestibular schwannoma growth: past, present and future. Acta Otolaryngol. 1998; 118: 327-32.

https://doi.org/10.1080/00016489850183395

PMid:9655205

Chen DA. Acoustic neuroma in a private neurotology practice: trends in demographics and practice patterns. Laryngoscope. 2007; 117(11): 2003-12.

https://doi.org/10.1097/MLG.0b013e3181373876

PMid:17828042

Cohen NL. Acoustic neuroma surgery with emphasis on preservation of hearing. Laryngoscope. 1979; 89: 886-96.

https://doi.org/10.1288/00005537-197906000-00004

PMid:449534

Cruz García O, López Farreras F, Fernández Melo R, Díaz Delgado D, Pérez Morales I, Castillo Hernández J, Jordan J, Sabatier CP. Conservación del facial en la cirugía de los schwannomas vestibulares. Mex Neuroci. 2005; 6(5): 364-71.

Dazert S, Aletsee C, Brors D, Mlynski R, Sudhoff H, Hildmann H, Helms J. Rare tumors of the internal auditory canal. Eur Arch Otorhinolaryngol. 2005; 262(7): 550-4.

https://doi.org/10.1007/s00405-003-0734-4

PMid:15947938

Ebersold MJ, Harner SG, Beatty CW, Harper CM, Quast LM. Current results of the retrosigmoid approach to acoustic neuroma. J Neurosurg. 1992; 76(6): 901-9.

https://doi.org/10.3171/jns.1992.76.6.0901

PMid:1588422

Evans DR. Neurofibromatosis type 2 (NF2): a clinical and molecular review. Orphanet J Rare Dis. 2009; 4(1): 16.

https://doi.org/10.1186/1750-1172-4-16

PMid:19545378 PMCid:PMC2708144

Fenton JE, Chin RY, Fagan PA, Sterkers O, Sterkers JM. Facial nerve monitoring parameters as a predictor of postoperative facial nerve outcomes after vestibular schwannoma resection. Otol Neurotol. 2011; 21(2): 99–102.

Fenton JE, Chin RY, Kalamarides M, Sterkers O, Sterkers JM, Fagan PA. Delayed facial palsy after vestibular schwannoma surgery. J Neurosurg. 2002; 97: 93-6.

https://doi.org/10.3171/jns.2002.97.1.0093

PMid:12134938

Fernández Cascón S, Fernández Morais R, Álvarez Otero R. Revisión sobre la importancia clínica del nistagmo espontáneo y de la prueba de agitación cefálica. Rev ORL. 2018; 9(2): 111-9.

Frommeld T, Maurer J, Mann W. Postoperative vestibular compensation and facial nerve function after acoustic neuroma operation. Relation to origin of the tumors. HNO. 1998; 46(4): 324-31.

https://doi.org/10.1007/s001060050247

PMid:9606646

House WF, Hittserlberger WE. The neuro-otologist’s view of the surgical management of acoustic neuromas. Clin Neurosurg. 1985; 32: 214-22.

PMid:3905138

House WF, Shelton C. Middle fossa approach for acoustic tumor removal. Otolaryngol Clin North Am. 1992; 25: 347-59.

PMid:1630833

House WF. Transtemporal bone microsurgical removal of acoustic neuromas: report of cases. Arch Otolaryngol. 1964; 80: 617-67.

PMid:14205464

Khrais T, Romano G, Sanna M. Nerve origin of vestibular schwannoma: a prospective study. J Laryngol Otol. 2007; 122: 128-31.

PMid:18039415

Komatsuzaki A, Tsunoda A. Nerve origin of the acoustic neuroma. J Laryngol Otol. 2001; 115(5): 376-9.

https://doi.org/10.1258/0022215011907910

PMid:11410128

Lalwani AK, Butt FY, Jackeler RK, Pitts LH, Yingling CD. Delayed onset facial nerve dysfunction following acoustic neuroma surgery. Am J Otol. 1995; 16(6): 758-64.

PMid:8572138

Lassaletta L, Gavilán J. An update on the treatment of vestibular schwannoma. Acta Otorrinolaringol Esp. 2009; 60:131-40.

https://doi.org/10.1016/S0001-6519(09)02010-X

https://doi.org/10.1016/S2173-5735(09)70116-4

Lee J, Fung K, Lownie SP, Parnes LS. Assessing impairment and disability of facial paralysis in patients with vestibular schwannoma. Arch Otolaryngol Head Neck Surg. 2007, January; 133(1): 56-60.

https://doi.org/10.1001/archotol.124.1.56

https://doi.org/10.1001/archotol.133.1.56

PMid:17224525

M, Bonnard D, Darrouzet V, Bellec O, Franco-Vidal V. Stage II vestibular schwannoma: predictive factors for postoperative hearing loss and facial palsy. Eur Ann Otorhinolaryngol Head Neck Dis. 2012; 129(2): 87-92.

https://doi.org/10.1016/j.anorl.2011.09.001

PMid:22226671

Morton RP, Ackerman PD, Pisansky MT, Krezalek M, Leonetti JP, Raffin MJ, Anderson DE. Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection. J Neurosurg. 2011; 114(2): 375-80.

https://doi.org/10.3171/2010.5.JNS091854

PMid:20578799

Prell J, Strauss C, Rachinger J, Alfieri A, Scheller C, Herfurth K, Rampp S. Facial nerve palsy after vestibular schwannoma surgery: dynamic risk-stratification based on continuous EMG-monitoring. Clin Neurophysiol. 2017; 65(5): 404-12.

Rivas A, Bohane K, Corrada H, Tan M, Tamargo R, Howard F. Model for early prediction of facial nerve recovery after vestibular schwannoma surgery. Otol Neurotol. 2011; 32(5): 826-33.

https://doi.org/10.1097/MAO.0b013e31821b0afd

PMid:21527865

Ruiz Aristegui MÁ, González-Orús Álvarez-Morujo RJ, Oviedo Martín C, Ruiz-Juretschke F, García Leal R, Yurrita BS. Surgical treatment of vestibular schwannoma. Review of 420 cases. Acta Otorrinolaringol Esp. 2015; 67(4): 201-11.

https://doi.org/10.1016/j.otorri.2015.09.003

https://doi.org/10.1016/j.otoeng.2015.09.001

Samii A, Brinker T, Kaminsky J, Wolfgang R, Samii M. Navigation guided opening of the internal auditory canal via the retrosigmoid route for acoustic neuroma surgery: cadaveric, radiological and preliminary clinical study. Neurosugery. 2000; 47(2): 382-8.

https://doi.org/10.1097/00006123-200008000-00021

Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg. 2006; 105(4): 527-35.

https://doi.org/10.3171/jns.2006.105.4.527

PMid:17044553

Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve-preservation and restitution of function. Neurosurgery. 1997; 40 (1): 684-95.

https://doi.org/10.1097/00006123-199704000-00006

PMid:9092841

Sampath P, Holliday M, Brem H, Niparko J, Long D. Facial nerve injury in acoustic neuroma (vestibular schwannoma) surgery: etiology and prevention. J Neurosurg. 1997; 87: 60-6.

https://doi.org/10.3171/jns.1997.87.1.0060

PMid:9202266

Sanna M, Bacciu A, Falcioni MD, Taibah A. Surgical management of jugular foramen schwannomas with hearing and facial nerve function preservation: a series of 23 cases and review of the literature. Laryngoscope. 2006; 116(12): 2191-204.

https://doi.org/10.1097/01.mlg.0000246193.84319.e5

PMid:17146395

Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol. 2006; 27(4): 547–52.

https://doi.org/10.1097/01.mao.0000217356.73463.e7

https://doi.org/10.1097/00129492-200606000-00018

PMid:16791048

Stott C, Albertz N, Aedo C. Neurinoma del acústico: revisión y actualización de la literatura. Rev Otorrinolaringol Cir Cabeza Cuello. 2008; 68(3): 301-8.

https://doi.org/10.4067/S0718-48162008000400012

Sughrue ME, Yang I, Aranda D, Rutkowski MJ, Fang S, Cheung SW, Parsa AT. Beyond audiofacial morbidity after gamma knife neurosurgery for vestibular schwannoma. J Neurosurg. 2011: 114(2); 381-5.

https://doi.org/10.3171/2009.10.JNS091203

https://doi.org/10.3171/2010.4.JNS091962

PMid:20486891

Tanrikulu L, Lohse P, Fahlbusch R, Naraghi R. Hearing preservation in acoustic neuroma resection: analysis of petrous bone measurement and intraoperative application. Surg Neurol Int. 2016; 7(40): 980–8.

https://doi.org/10.4103/2152-7806.195572

PMid:28144470 PMCid:PMC5234277

Tos M, Charabi S, Thomsen J. Incidence of vestibular schwannomas. Laryngoscope. 1999; 109(5): 736-40.

https://doi.org/10.1097/00005537-199905000-00011

PMid:10334223

Veronezi RJ, Fernandes YB, Borges G, Ramina R. Long term facial nerve clinical evaluation following vestibular schwannoma surgery. Arq Neuropsiquiatr. 2008; 66(2): 194-8.

https://doi.org/10.1590/S0004-282X2008000200010

PMid:18545781

Xu F, Pan S, Alonso F, Dekker SE, Bambakidis NC. Intracranial facial nerve schwannomas: current management and review of literature. World Neurosurg. 2017; 100: 444-9.

https://doi.org/10.1016/j.wneu.2016.09.082

PMid:27693767

Zaouche S, Lonescu E, Dubreuil C, Ferber-Viart C. Pre- and intraoperative predictive factors of facial palsy in vestibular schwannoma surgery. Acta Otolaryngol. 2005; 125 (4): 363-9.

https://doi.org/10.1080/00016480410025216

PMid:15823806




DOI: http://dx.doi.org/10.14201/orl.20152

Enlaces refback

  • No hay ningún enlace refback.


ESCI Web of Science