Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Significance of Preoperative Nerve Reconstruction Using Diffusion Tensor Imaging Tractography for Facial Nerve Protection in Vestibular Schwannoma

  • Yuanlong Zhang (Department of of Neurosurgery, The First Affiliated Hospital, Fujian Medical University) ;
  • Hongliang Ge (Department of of Neurosurgery, The First Affiliated Hospital, Fujian Medical University) ;
  • Mingxia Xu (Department of of Neurosurgery, The First Affiliated Hospital, Fujian Medical University) ;
  • Wenzhong Mei (Department of of Neurosurgery, The First Affiliated Hospital, Fujian Medical University)
  • Received : 2022.06.08
  • Accepted : 2022.10.09
  • Published : 2023.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The facial nerve trace on the ipsilateral side of the vestibular schwannoma was reconstructed by diffusion tensor imaging tractography to identify the adjacent relationship between the facial nerve and the tumor, and to improve the level of intraoperative facial nerve protection. Methods : The clinical data of 30 cases of unilateral vestibular schwannoma who underwent tumor resection via retrosigmoid approach were collected between January 2019 and December 2020. All cases underwent magnetic resonance imaging examination before operation. Diffusion tensor imaging and anatomical images were used to reconstruct the facial nerve track of the affected side, so as to predict the course of the nerve and its adjacent relationship with the tumor, to compare the actual trace of the facial nerve during operation, verify the degree of coincidence, and evaluate the nerve function (House-Brackmann grade) after surgery. Results : The facial nerve of 27 out of 30 cases could be displayed by diffusion tensor imaging tractography, and the tracking rate was 90% (27/30). The intraoperative locations of facial nerve shown in 25 cases were consistent with the preoperative reconstruction results. The coincidence rate was 92.6% (25/27). The facial nerves were located on the anterior middle part of the tumor in 14 cases, anterior upper part in eight cases, anterior lower part in seven cases, and superior polar in one case. Intraoperative facial nerve anatomy was preserved in 30 cases. Among the 30 patients, total resection was performed in 28 cases and subtotal resection in two cases. The facial nerve function was evaluated 2 weeks after operation, and the results showed grade I in 12 cases, grade II in 16 cases and grade III in two cases. Conclusion : Preoperative diffusion tensor imaging tractography can clearly show the trajectory and adjacent position of the facial nerve on the side of vestibular schwannoma, which is beneficial to accurately identify and effectively protect the facial nerve during the operation, and is worthy of clinical application and promotion.

Keywords

Acknowledgement

This study is supported by Startup Fund for scientific research, Fujian Medical University (grant No. 2018QH1079, 2019QH1087) and Guiding Project of Fujian Science and Technology Department (grant No. 2016Y0037,2021Y0013).

References

  1. Baro V, Landi A, Brigadoi S, Castellaro M, Moretto M, Anglani M, et al. : Preoperative prediction of facial nerve in patients with vestibular schwannomas: the role of diffusion tensor imaging-a systematic review. World Neurosurg 125 : 24-31, 2019 https://doi.org/10.1016/j.wneu.2019.01.099
  2. Borkar SA, Garg A, Mankotia DS, Joseph SL, Suri A, Kumar R, et al. : Prediction of facial nerve position in large vestibular schwannomas using diffusion tensor imaging tractography and its intraoperative correlation. Neurol India 64 : 965-970, 2016 https://doi.org/10.4103/0028-3886.190270
  3. Chen DQ, Quan J, Guha A, Tymianski M, Mikulis D, Hodaie M : Threedimensional in vivo modeling of vestibular schwannomas and surrounding cranial nerves with diffusion imaging tractography. Neurosurgery 68 : 1077-1083, 2011 https://doi.org/10.1227/NEU.0b013e31820c6cbe
  4. Chen X, Weigel D, Ganslandt O, Buchfelder M, Nimsky C : Prediction of visual field deficits by diffusion tensor imaging in temporal lobe epilepsy surgery. Neuroimage 45 : 286-297, 2009 https://doi.org/10.1016/j.neuroimage.2008.11.038
  5. Choi KS, Kim MS, Kwon HG, Jang SH, Kim OL : Preoperative identification of facial nerve in vestibular schwannomas surgery using diffusion tensor tractography. J Korean Neurosurg Soc 56 : 11-15, 2014 https://doi.org/10.3340/jkns.2014.56.1.11
  6. Gerganov VM, Giordano M, Samii M, Samii A : Diffusion tensor imagingbased fiber tracking for prediction of the position of the facial nerve in relation to large vestibular schwannomas. J Neurosurg 115 : 1087-1093, 2011 https://doi.org/10.3171/2011.7.JNS11495
  7. Gurgel RK, Theodosopoulos PV, Jackler RK : Subtotal/near-total treatment of vestibular schwannomas. Curr Opin Otolaryngol Head Neck Surg 20 : 380-384, 2012 https://doi.org/10.1097/MOO.0b013e328357b220
  8. Heros RC, Bhatia R : Editorial: vestibular schwannoma and the facial nerve. J Neurosurg 116 : 695-696; discussion 696, 2012 https://doi.org/10.3171/2011.10.JNS111717
  9. Hilly O, Chen JM, Birch J, Hwang E, Lin VY, Aviv RI, et al. : Diffusion tensor imaging tractography of the facial nerve in patients with cerebellopontine angle tumors. Otol Neurotol 37 : 388-393, 2016 https://doi.org/10.1097/MAO.0000000000000984
  10. Hodaie M, Quan J, Chen DQ : In vivo visualization of cranial nerve pathways in humans using diffusion-based tractography. Neurosurgery 66 : 788-795; discussion 795-796, 2010 https://doi.org/10.1227/01.NEU.0000367613.09324.DA
  11. Hong W, Cheng H, Wang X, Feng C : Influencing factors analysis of facial nerve function after the microsurgical resection of acoustic neuroma. J Korean Neurosurg Soc 60 : 165-173, 2017 https://doi.org/10.3340/jkns.2013.0407.001
  12. House JW, Brackmann DE : Facial nerve grading system. Otolaryngol Head Neck Surg 93 : 146-147, 1985 https://doi.org/10.1177/019459988509300202
  13. Ma J, Su S, Yue S, Zhao Y, Li Y, Chen X, et al. : Preoperative visualization of cranial nerves in skull base tumor surgery using diffusion tensor imaging technology. Turk Neurosurg 26 : 805-812, 2016
  14. Matthies C, Samii M : Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 40 : 1-9; discussion 9-10, 1997 https://doi.org/10.1097/00006123-199701000-00001
  15. Nakao Y, Piccirillo E, Falcioni M, Taibah A, Kobayashi T, Sanna M : Electromyographic evaluation of facial nerve damage in acoustic neuroma surgery. Otol Neurotol 22 : 554-557, 2001 https://doi.org/10.1097/00129492-200107000-00024
  16. Neff BA, Ting J, Dickinson SL, Welling DB : Facial nerve monitoring parameters as a predictor of postoperative facial nerve outcomes after vestibular schwannoma resection. Otol Neurotol 26 : 728-732, 2005 https://doi.org/10.1097/01.mao.0000178137.81729.35
  17. Nimsky C, Ganslandt O, Fahlbusch R : Implementation of fiber tract navigation. Neurosurgery 61 : 306-317; discussion 317-318, 2007 https://doi.org/10.1227/01.neu.0000279224.83998.7d
  18. Pierpaoli C, Jezzard P, Basser PJ, Barnett A, Di Chiro G : Diffusion tensor MR imaging of the human brain. Radiology 201 : 637-648, 1996 https://doi.org/10.1148/radiology.201.3.8939209
  19. Propper RE, O'Donnell LJ, Whalen S, Tie Y, Norton IH, Suarez RO, et al. : A combined fMRI and DTI examination of functional language lateralization and arcuate fasciculus structure: effects of degree versus direction of hand preference. Brain Cogn 73 : 85-92, 2010 https://doi.org/10.1016/j.bandc.2010.03.004
  20. Roundy N, Delashaw JB, Cetas JS : Preoperative identification of the facial nerve in patients with large cerebellopontine angle tumors using high-density diffusion tensor imaging. J Neurosurg 116 : 697-702, 2012 https://doi.org/10.3171/2011.12.JNS111404
  21. Samala R, Borkar SA, Sharma R, Garg A, Suri A, Gupta D, et al. : Effectiveness of preoperative facial nerve diffusion tensor imaging tractography for preservation of facial nerve function in surgery for large vestibular schwannomas: results of a prospective randomized study. Neurol India 67 : 149-154, 2019
  22. Samii M, Matthies C : Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40 : 11-21; discussion 21-23, 1997 https://doi.org/10.1227/00006123-199701000-00002
  23. 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 105 : 527- 535, 2006 https://doi.org/10.3171/jns.2006.105.4.527
  24. Sampath P, Rini D, Long DM : Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases. J Neurosurg 92 : 70-78, 2000 https://doi.org/10.3171/jns.2000.92.1.0070
  25. Song F, Hou Y, Sun G, Chen X, Xu B, Huang JH, et al. : In vivo visualization of the facial nerve in patients with acoustic neuroma using diffusion tensor imaging-based fiber tracking. J Neurosurg 125 : 787-794, 2016 https://doi.org/10.3171/2015.7.JNS142922
  26. Taoka T, Hirabayashi H, Nakagawa H, Sakamoto M, Myochin K, Hirohashi S, et al. : Displacement of the facial nerve course by vestibular schwannoma: preoperative visualization using diffusion tensor tractography. J Magn Reson Imaging 24 : 1005-1010, 2006 https://doi.org/10.1002/jmri.20725
  27. Youssef AS, Downes AE : Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications. Neurosurg Focus 27 : E9, 2009
  28. Zanoletti E, Faccioli C, Martini A : Surgical treatment of acoustic neuroma: outcomes and indications. Rep Pract Oncol Radiother 21 : 395-398, 2016 https://doi.org/10.1016/j.rpor.2015.11.002
  29. Zhang Y, Chen Y, Zou Y, Zhang W, Zhang R, Liu X, et al. : Facial nerve preservation with preoperative identification and intraoperative monitoring in large vestibular schwannoma surgery. Acta Neurochir (Wien) 155 : 1857-1862, 2013 https://doi.org/10.1007/s00701-013-1815-9