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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Postoperative facial nerve function after removal of skull base meningiomas involving the internal auditory canal

Meeting Abstract

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  • Guilherme Montibeller - Neurological Institute of Curitiba, Curitiba, Brazil
  • Mauricio Coelho Neto - Neurological Institute of Curitiba, Curitiba, Brazil
  • Ricardo Ramina - Neurological Institute of Curitiba, Curitiba, Brazil

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.18.04

doi: 10.3205/17dgnc281, urn:nbn:de:0183-17dgnc2819

Published: June 9, 2017

© 2017 Montibeller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Meningiomas arising within or around the internal auditory canal (IAC) may involve or infiltrate the facial and vestibulocochlear nerves. Surgical removal of tumor extension inside of the IAC preserving the function of involved cranial nerves is a challenge. The object of this study is to evaluate the outcome of facial nerve function after surgical removal of these tumors.

Methods: A series of 55 meningiomas with IAC involvement is presented. Tumor origin was the petroclival region in 40 cases (from a series of 107 surgically removed petroclival meningiomas), the cerebelo pontine angle (CPA) in 9 patients (from a series of 39 cases) and pure intrameatal menigiomas in 6 cases. The tumors were removed through the retrosigmoid/transmetal (49 cases) and presigmoid (6 cases) approaches. The outcome of facial nerve function was evaluated according to the House & Brackmann (H&B) scale.

Results: Radical removal of tumor extension inside the IAC was possible in all cases. According to H&B scale the postoperative facial nerve function was: Grade I = 13 cases, Grade II = 20 cases, Grade III = 9 cases, Grade IV = 5 cases and Grade VI = 8 cases (transient in 5). VII/XII anastomosis was performed in the three cases. Hearing preservation was possible in 17 cases out of 40 patients with preoperative hearing. There was no mortality in this series.

Conclusion: Grade of involvement of IAC was an important factor in functional preservation of facial nerve and hearing. More drilling and wider exposure of the IAC is needed in comparison to vestibular schwannomas and the rate of facial nerve function preservation was lower. Removal of infiltrated dura inside the IAC is required to obtain grade 1 Simpson’s resection. CPA meningiomas presented a higher rate of hearing preservation than petroclival meningiomas.