The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation / A abordagem extracisternal na cirurgia de schwannoma vestibular e preservação do nervo facial

The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor. .

A técnica cirúrgica clássica para ressecção de schwannomas vestibulares enfatiza a anatomia microcirúrgica dos nervos cranianos. Acreditamos que o foco na preservação da membrana aracnóide pode servir como parâmetro seguro para a remoção do tumor. Método A abordagem extracisternal é descrita em detalhe. Analisamos o prontuário de 120 pacientes tratados com esta técnica entre 2006 e 2012. Os resultados cirúrgicos foram baseados em extensão de ressecção, recorrência tumoral e função do nervo facial. Resultados Ressecção total foi obtida em 81% dos pacientes. O resultado global da função do nervo facial (House-Brackmann graus I-II) após um ano da cirurgia foi de 93%. Não houve recidiva em um seguimento médio de 4,2 anos. Conclusão A técnica extracisternal difere de outras descrições cirúrgicas no tratamento de schwannoma vestibular pois não requer a identificação do nervo facial, contanto que o plano de aracnóide seja preservado em toda circunferência do tumor. .

Parotidectomy--a prospective study.

Preservation of facial nerve is a real challenge in parotidectomy. Total conservative parotidectomy and superficial parotidectomy are the commonly practised operations for parotid diseases. Twelve patients have undergone total conservative parotidectomy and 52 patients have undergone superficial perotidectomy with preservation of integrity and function of the facial nerve and its branches. Fifty-eight patients were suffering from neoplastic conditions of which 46 had pleomorphic adenoma, 7 had muco-epidermoid carcinoma, 3 had carcinoma ex-pleomorphic adenoma, and 2 had adenoid cystic carcinoma. Non-neoplastic conditions were seen in 6 cases of which 3 had chronic parotitis and 3 had congenital parotid fistula. The aim of the study was to observe the efficacy of preservation of facial nerve in parotidectomy done in 64 patients.