Hypoglossal-facial anastomosis, tricks and trade

Total removal of difficult tumours at the skull base left behind a traumatized facial nerve previously aggressed by the tumour. Reanimation of the nerve was mandatory in order to recover functional and cosmetic results. Despite an additional XII[th] cranial nerve morbidity, hypoglossal-facial nerve anastomosis was still a gold standard to reach this goal. The authors present their experience in managing 11 cases of facial nerve reanimation after skull base tumour resection by using the descending branch of the hypoglossal nerve as axon donator for direct facial anastomosis. Outcome of facial reanimation according to House-Brackmann classification was good [grade I, II and III] in 5 cases, mild [grade IV] in 3 cases and bad [grade IV and V] in 3 cases. Hemi tongue atrophy occurred in none of our patients. Hypoglossal-facial nerve anastomosis using the descending branch of the XII[th] cranial nerve is an effective procedure to reanimate the facial nerve without additional morbidity. Early reanimation of the facial nerve is the key to offer resumption of normal life for these patients who had already undergone a major neurosurgical procedure

Brain metastases: surgery, radiosurgery and whole-brain radiation therapy

The brain is a preferred site of metastatic spread in cancer patients. Once a brain metastasis has been diagnosed, the median life expectancy is less than one year. The prognosis of patients with brain metastases predominantly depends on age and Kamofsky performance status, as well as extracranial disease activity. There is still much controversy conceming the optimum treatment for metastatic brain disease. In many patients, aggressive treatment of metastatic disease has been shown to restore neurological function and prevent further neurological manifestations. Selection of patients for aggressive treatment strategies should thus be based on objective criteria. The emphasis of this review is on currently relevant factors for diagnosis, surgery, whole-brain radiation therapy and methods of radiosurgery