Comparative assessment of methods of the operative treatment of facial nerve damage caused during cerebellopontine angle neurinoma and meningioma removals

Abstract

The aim of this research paper is to point out the preconditions for facial nerve damage during CPA tumour removals and, in such cases, the appropriate choice of reconstructive surgery. Materials and methods. In Uzhhorod National University, during the period of 2008 to 2019, surgical treatment of 212 patients with neurinomas and meningiomas of the CPA has been carried out. We have analyzed the cases of 35 (16.5%) patients with intraoperative damage of the facial nerve. The mentioned 35 patients underwent appropriate clinical examinations during the post-operative period, which confirmed the facial nerve damage to one degree or another according to the House-Brackmann scale. The clinical signs manifested as full eyelid contact with slight effort and slight facial asymmetry during maximal effortful laughter. Slight synkinesias were noticeable, and there were no contractures until the expression of clinical signs corresponding to grade 6 - total nerve paralysis in 5 patients. Results. The research demonstrated that patients with neurinomas larger than 3 cm in size are 5 times more likely to undergo intraoperative damage to the facial nerve than patients with the same tumour but 3 cm or less in size and 5 times more likely than patients with meningiomas as a whole. In the group of patients aged 20-40, there were twice as many men; in the group aged 40-50, women predominated; among patients older than 50, there were equal numbers of men and women. Remote catamnesis was traced in 19 patients, and contact with the rest of the patients was lost due to the war. Among the interviewed patients, 58% of the anastomosis was performed in the first 3 months after the initial surgery, 21% - in 4-6 months, and 21% - in more than 12 months. The optimal timing of reinnervation after the initial surgery is the first 6 months after tumour removal. Сonclusions. Nerve damage is more common during the removal of neurinomas 4cm or bigger in size. Reinnervation is accomplished by anastomosing the central end of the hypoglossal or accessory nerves to the peripheral end of the facial nerve, and both procedures are equally effective. Reinnervation should be performed 2 to 3 months after confirming nerve injury, but no later than 6 months.