Rerouting Technique of the Facial Nerve in the Procedure of Removal of Jugular Foramen Tumors: Outcomes and Indications

Abstract

But de la presentation To analyze retrospectively the functional outcome of the facial nerve after different nerve rerouting techniques in the procedure of removal of jugular foramen tumors, and to discuss their indications. Materiel et methodes From 2004 to 2013, 47 patients with jugular foramen tumor were operated on, in which 40 were totally, six near-totally and 1 partially resected. The pathologies consisted of 35 jugular paragangliomas, six schwannomas, 4 chordomas, one synovial sarcoma, and one ossifying myxoid tumor. According to the location and extension of the tumors, infra-temporal fossa type A (IFTA) approach was carried out in 23 cases, infra-temporal fossa combined translabyrinthine approach in 10 cases, petro-occipital trans-sigmoid approach (POTS) in 14 cases. The total rerouting of the facial nerve was done in 14 cases, partial rerouting in 12 cases, and no rerouting in 21 cases. Resultats These patients were followed up for 1-10 years. The facial nerve function after one year was HB I-II in 28 cases, HB III-IV in 17 cases, and HB V-VI in two cases. The facial nerve function after three years was HB I-II in 35 cases and HB III-IV in eight cases. The facial nerve function was deteriorated in 18 cases, improved in two cases, and unchanged in 27 cases. Conclusion The intraoperative facial nerve injury is a common complication in the surgery of jugular foramen tumors. The nature, size, location of tumors, preoperative facial function, surgical approach and intraoperative nerve management could affect the prognosis of facial nerve function. Partial or no rerouting of the facial nerve could be used in the procedure of removal of jugular foramen tumors in order to obtain better facial function. The tumors, those posterior and inferior to the labyrinth, could be removed via IFTA with partial or no rerouting of the facial nerve or POTS.