The American journal of otology
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The subtemporal transpetrous approach to the petroclival region uses a combination of techniques, including a petrosectomy and a subtemporal and suboccipital craniotomy. Ligation of the greater petrosal sinus, sigmoid sinus, and retraction of the temporal lobe affords wide exposure to the petroclival region and ventral brainstem and minimizes the need for facial nerve translocation. This approach has been successfully used in the management of 10 large tumors of the region, including chondrosarcomas, chordomas, meningiomas, and schwannomas. The history and evolution of this technique and its relation to other similar approaches is discussed.
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Pain subsequent to resection of acoustic neuromas via suboccipital and translabyrinthine approaches.
Prolonged headache subsequent to excision of acoustic neuromas via a suboccipital approach has been cited as a significant complication of this procedure. However, few studies have sought to compare the incidence of postoperative headaches in patients undergoing either translabyrinthine or suboccipital approaches with surgical techniques designed to minimize this complication. We performed a retrospective survey of 52 patients having undergone either a suboccipital or translabyrinthine resection of acoustic neuromas. ⋯ However, by 1 year after surgery, these differences are no longer significant. Thus the complication of long-term postoperative headache is no more prevalent in patients undergoing a suboccipital resection than in those having undergone translabyrinthine surgery. These results are important to both the surgeon and the patient during preoperative counseling regarding the choice of surgical approach for acoustic neuroma excision.
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The suboccipital approach used for cerebellopontine angle tumors, microvascular decompression, vestibular nerve section, and other procedures has been associated with significant postoperative headache. This study was undertaken to evaluate retrospectively the incidence and management of headaches in these patients. ⋯ Cranioplasty at the time of lateral craniectomy appears to reduce the incidence of debilitating postoperative headache.
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Patients with satisfactory facial nerve function [House-Brackmann (HB) grade I or II] immediately after acoustic neuroma surgery are at risk for delayed facial paralysis. To study this problem, 255 consecutive patients who underwent acoustic neuroma excision with facial nerve preservation were identified. Delayed facial paralysis occurred in 62 (24.3%) patients; 90% ultimately recovered to their initial postoperative HB grade, and 98.3% recovered to within one grade of their initial HB level. ⋯ Of patients who demonstrated nerve deterioration to grades IV-VI, 20 of 38 required tarsorrhaphy or gold-weight placement. We conclude that the over-whelming majority of patients with delayed facial paralysis after acoustic neuroma surgery do eventually recover to their postoperative HB grade. The magnitude and timecourse of delayed facial paralysis are predictive factors for subsequent recovery.
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Delayed onset facial nerve dysfunction following acoustic neuroma surgery is an under-appreciated phenomenon. The authors have recently reviewed long-term (> 1 year) facial nerve outcome in 129 patients who underwent acoustic neuroma removal with the aid of cranial nerve monitoring between 1986 and 1990. The facial nerve was anatomically preserved in 99.2% of the patients, and at one year, 90% of all the patients had House-Brackmann (H-B) grade I or II facial nerve function. ⋯ In the majority of cases, the recovery was complete within the first 6 months without specific treatment. Comparable to the patients without delayed palsies, 89% (34 of 38) of the cases had H-B grade I or II and 97% (37 of 38) had H-B grade III or better facial nerve function at 1 year. This review suggests a surprisingly high incidence of delayed facial palsy following acoustic neuroma surgery, which fortunately has an excellent prognosis for spontaneous recovery.