Vestibular schwannoma surgery. Risk and predictive factors of facial palsy
Abstract Introduction and objective: To identify the pre and perioperative factors that may predict the development of facial paralysis after vestibular schwannoma surgery. Methods: Pre- and postoperative clinical data were determined, and radiological and surgical findings were collected and evaluated in a large database of 291 patients diagnosed with vestibular schwannoma at the Department of Otorhinolaryngology and Cervicofacial Surgery from 1995 to 2017 at the University Hospital of Salamanca. Results: of the 140 patients who were operated and completed the follow-up, 44.4% had FP grade I, 6.8% grade II, 3.8% grade III, 8.3% grade IV, 10.5% grade V, 26.3% grade VI. After 6 months, 51.9% had grade I, 11.1% grade II, 10.4% grade III, 7.4% grade IV, 8.1% grade V, and 11.1% grade VI. Tumor grade III-IV, retrosigmoid approach, complete tumor excision, an abnormal electroneurography of facial nerve result, non-preservation of the hearing and an abnormal videonystagmography result were significant. Discussion and conclusion: The most important predictive factors are the size of the tumor and the surgical approach.
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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
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
Marcos-Alonso, S., Villaoslada-Fuentes, R., Muñoz-Herrera, Ángel, Batuecas-Caletrío, Ángel, Santa-cruz-ruíz, S., & Martínez-Carranza, R. A. (2019). Vestibular schwannoma surgery. Risk and predictive factors of facial palsy. Revista ORL, 10(3), 181–192. https://doi.org/10.14201/orl.20152
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- Paula Peña-Navarro, Sofía Pacheco-López, Cristina Nicole Almeida-Ayerve, Susana Marcos-Alonso, Fernando Benito-González, Enrique Calvo-Boizas, Cholesteatoma of the External Auditory Canal in Childhood , Revista ORL: Vol. 13 No. S2 (2022): XXVIII Congreso de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja Valladolid 2, 3 y 4 de junio de 2022
- Maria Marco-Carmona, Aurymar Fraino, Erwin Racines-Álava, Jose Francisco Asensio-Calle, Jose Manuel Villanueva-Rincón, Gabriel Trinidad-Ruiz, Ángel Batuecas-Caletrío, The role of MRI in the diagnosis of audio-vestibular pathology , Revista ORL: Vol. 15 No. 1 (2024)
- Ángel Muñoz-Herrera, José Santiago Estévez-Alonso, Complications and sequelae of the treatment of upper aerodigestive tumors , Revista ORL: Segovia 2018
- Rosalyn Chaves Araujo, María José Fernández-Nava, Rosana Villaoslada-Fuentes, Sandra Martín-García, Alejandro Tamayo-Esquinas, Erwin Alejandro Racines-Álava, Paula Pérez-Chacón, Rafael Álvarez-Otero, Episodic syndromes that may be associated with migraine , Revista ORL: Online Continuous Publication
- Cristina Nicole Almeida-Ayerve, María José Fernández-Nava, Susana Marcos-Alonso, Sofía Ferreira-Cendón, Guillermo Salib Coronel-Touma, Pedro Blanco-Perez, T-Type lymphoproliferative disorder in the tongue: case report , Revista ORL: Vol. 13 No. S2 (2022): XXVIII Congreso de la Sociedad Otorrinolaringológica de Castilla y León, Cantabria y La Rioja Valladolid 2, 3 y 4 de junio de 2022
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