Shaun D. Rodgers, Y. Moshel, I. Mikolaenko, Alexander J. Gilbert, R. Babu
The authors report the case of a 51-year-old male that presented with hypertension and arm pain 5 years after combined transcranial and transfacial resection followed by radiotherapy for esthesioneuroblastoma. Laboratory studies revealed hypokalemia and elevated serum cortisol and ACTH levels. Brain magnetic resonance imaging (MRI) revealed a left-sided contrast-enhancing extra-axial dural-based lesion along the convexity. After resection of the convexity tumor, histological examination identified the lesion as recurrent esthesioneuroblastoma and serum ACTH and cortisol levels returned to near normal. Ectopic ACTH production from esthesioneuroblastoma is extremely rare and only six cases have been reported. This case report will describe the clinical presentation and pathology of recurrent esthesioneuroblastoma and review the literature.
{"title":"Recurrent Esthesioneuroblastoma Presenting as an ACTH Paraneoplastic Syndrome","authors":"Shaun D. Rodgers, Y. Moshel, I. Mikolaenko, Alexander J. Gilbert, R. Babu","doi":"10.5580/2b51","DOIUrl":"https://doi.org/10.5580/2b51","url":null,"abstract":"The authors report the case of a 51-year-old male that presented with hypertension and arm pain 5 years after combined transcranial and transfacial resection followed by radiotherapy for esthesioneuroblastoma. Laboratory studies revealed hypokalemia and elevated serum cortisol and ACTH levels. Brain magnetic resonance imaging (MRI) revealed a left-sided contrast-enhancing extra-axial dural-based lesion along the convexity. After resection of the convexity tumor, histological examination identified the lesion as recurrent esthesioneuroblastoma and serum ACTH and cortisol levels returned to near normal. Ectopic ACTH production from esthesioneuroblastoma is extremely rare and only six cases have been reported. This case report will describe the clinical presentation and pathology of recurrent esthesioneuroblastoma and review the literature.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122889685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Koul, A. Dubey, V. Torri, A. .. Kakumanu, Kunal Goyal
Glioblastoma multiforme (GBM) is the most common and aggressive primary brain malignancy in the human race. The management of glioblastoma multiforme (GBM) in elderly patients is not well established in English literature. Despite treatment advances, survival of elderly GBM patients is usually < 12 months. Prognostically favorable elderly GBM patients should be included in prospective randomized combined-modality clinical trials. Quality-of-life issues should be strongly considered in this subset of patients. This is the review article looking into the pattern of presentation, treatment, and other related aspects in this subset of patients as management of glioblastoma multiforme (GBM) in elderly patients is not well established.
{"title":"Glioblastoma Multiforme In Elderly Population","authors":"R. Koul, A. Dubey, V. Torri, A. .. Kakumanu, Kunal Goyal","doi":"10.5580/2b2b","DOIUrl":"https://doi.org/10.5580/2b2b","url":null,"abstract":"Glioblastoma multiforme (GBM) is the most common and aggressive primary brain malignancy in the human race. The management of glioblastoma multiforme (GBM) in elderly patients is not well established in English literature. Despite treatment advances, survival of elderly GBM patients is usually < 12 months. Prognostically favorable elderly GBM patients should be included in prospective randomized combined-modality clinical trials. Quality-of-life issues should be strongly considered in this subset of patients. This is the review article looking into the pattern of presentation, treatment, and other related aspects in this subset of patients as management of glioblastoma multiforme (GBM) in elderly patients is not well established.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126010070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tracy S. Ma, Benjamin A. Rubin, B. Grobelny, D. Zagzag, M. Koslow, I. Mikolaenko, Robert E. Elliott
Paraganglioma (PGL) of the filum terminale is a rare tumor of extra-adrenal paraganglia. The reported cases of filum terminale and cauda equina PGLs often present with low-back pain and sciatica. While sensory or motor deficits and paraplegia may occur, the incidence is relatively low. We present a case of a 51-year old male with hemorrhagic paraganglioma of the filum terminale. He presented with acute paraplegia and was treated via emergent laminectomy, evacuation of hematoma, and resection of tumor. The patient had a significant but incomplete neurological recovery. The clinical, radiologic, and histopathological characteristics of the condition are described.
{"title":"Acute Paraplegia From Hemorrhagic Paraganglioma Of Filum Terminale: Case Report And Review Of Literature","authors":"Tracy S. Ma, Benjamin A. Rubin, B. Grobelny, D. Zagzag, M. Koslow, I. Mikolaenko, Robert E. Elliott","doi":"10.5580/2a87","DOIUrl":"https://doi.org/10.5580/2a87","url":null,"abstract":"Paraganglioma (PGL) of the filum terminale is a rare tumor of extra-adrenal paraganglia. The reported cases of filum terminale and cauda equina PGLs often present with low-back pain and sciatica. While sensory or motor deficits and paraplegia may occur, the incidence is relatively low. We present a case of a 51-year old male with hemorrhagic paraganglioma of the filum terminale. He presented with acute paraplegia and was treated via emergent laminectomy, evacuation of hematoma, and resection of tumor. The patient had a significant but incomplete neurological recovery. The clinical, radiologic, and histopathological characteristics of the condition are described.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134365352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
“I am locked in. I am as good as dead” [1]. Name: Jean-Dominique Bauby (Jean-Do)
“我被锁在里面了。我跟死了差不多”[1]。名字:让-多米尼克·鲍比(Jean-Do)
{"title":"Editorial: A Butterfly Locked-In A Diving-Bell – Is Freedom Possible?","authors":"G. Matis, Danilo Silva, O. Chrysou, T. Birbilis","doi":"10.5580/2c4c","DOIUrl":"https://doi.org/10.5580/2c4c","url":null,"abstract":"“I am locked in. I am as good as dead” [1]. Name: Jean-Dominique Bauby (Jean-Do)","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116078344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A gunshot wound to the spine is a complex injury and is a major cause of spinal cord injury (SCI) globally among civilian populations, members of the military armed conflict personnel, or civilians injured in terrorists’ attacks. The bullet fragments may cause damage to the spinal cord directly and/or indirectly even without penetrating the spinal canal by concussive effects, heat, fractures or vascular injury. Regardless of injury level, new-onset or progressive neurologic deterioration is an indication for urgent decompression. In this article we report a case of a gunshot wound to the cervical spine with progressive neurological deterioration.
{"title":"Gunshot Injury To The Cervical Spine With Progressive Neurological Deterioration - A Case Report","authors":"M. Salek, M. Mannan","doi":"10.5580/2b2c","DOIUrl":"https://doi.org/10.5580/2b2c","url":null,"abstract":"A gunshot wound to the spine is a complex injury and is a major cause of spinal cord injury (SCI) globally among civilian populations, members of the military armed conflict personnel, or civilians injured in terrorists’ attacks. The bullet fragments may cause damage to the spinal cord directly and/or indirectly even without penetrating the spinal canal by concussive effects, heat, fractures or vascular injury. Regardless of injury level, new-onset or progressive neurologic deterioration is an indication for urgent decompression. In this article we report a case of a gunshot wound to the cervical spine with progressive neurological deterioration.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130388830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although an uncommon injury, bilateral dissection of the internal carotid arteries can have devastating consequences. Awareness and diagnosis has risen since it was described in 1967 by Yamada et al. However, given the vague presentation and difficulty in diagnosis, it is important to identify all associated signs and symptoms. We present a previously unreported finding of bilateral hyperdense middle cerebral arteries in the absence of previously described contributing factors. Knowledge of this highly specific sign in patients involved in airbag-associated motor vehicle accidents can contribute to the early diagnosis and treatment of such patients.
{"title":"Airbag Associated Bilateral Internal Carotid Artery Dissection with Hyperdense Middle Cerebral Artery Sign - A Case Report","authors":"A. Medhkour, Abdul Kader Tabbara","doi":"10.5580/1a9f","DOIUrl":"https://doi.org/10.5580/1a9f","url":null,"abstract":"Although an uncommon injury, bilateral dissection of the internal carotid arteries can have devastating consequences. Awareness and diagnosis has risen since it was described in 1967 by Yamada et al. However, given the vague presentation and difficulty in diagnosis, it is important to identify all associated signs and symptoms. We present a previously unreported finding of bilateral hyperdense middle cerebral arteries in the absence of previously described contributing factors. Knowledge of this highly specific sign in patients involved in airbag-associated motor vehicle accidents can contribute to the early diagnosis and treatment of such patients.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122055268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. A. Khachatrian, K. Samochernykh, D. Simonyan, A. V. Kim, Iu M Zabrodskaia, A. Khodorovskaya
In this work a group of authors is looking into perspective of minimal invasive procedures in treatment of colloid cysts. An extensive literature review is accompanied by a number of own observations and treatments of cranial colloid cysts by open and endoscopic methods.
{"title":"Minimally Invasive Option for Colloid Cysts Treatment.","authors":"V. A. Khachatrian, K. Samochernykh, D. Simonyan, A. V. Kim, Iu M Zabrodskaia, A. Khodorovskaya","doi":"10.5580/286b","DOIUrl":"https://doi.org/10.5580/286b","url":null,"abstract":"In this work a group of authors is looking into perspective of minimal invasive procedures in treatment of colloid cysts. An extensive literature review is accompanied by a number of own observations and treatments of cranial colloid cysts by open and endoscopic methods.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123374145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The overall complication rate for endovascular coil embolization of cerebral aneurysms is 5% percent. This is an illustrative case series that describes management aspects and probable precipitants of adverse events during coil embolization and related imaging and clinical outcomes. Major intraprocedural intracranial adverse events during endovascular coil embolization of cerebral aneurysms can be divided into three categories. Thromboembolic, aneurysm or parent vessel perforations/ruptures and embolysate related. Clinical case examples with rescue intervention and outcomes are discussed within each category. 1) Thromboembolic (Case 1 and 2): This is the most frequent complication and cause of morbidity and mortality. Thromboembolic may occur consequent to failure of sustained and or sufficient systemic anticoagulation. Prevention of localized platelet and clotting cascade activation in the context of thrombogenic device introduction for coil embolization is vital in preventing partial or complete parent, branch or distal vessel occlusion. Embolic propagation of thrombus may arise from native vessel disease and or consequent to mechanical device manipulation during coil delivery and deployment, as well as with the use of adjuncts such as balloon assist. Frequent monitoring of ACT (Activated Clotting Time) values for systemic anticoagulation with Heparin to confirm twice the baseline value is the primary preventative method. Intraprocedural pharmacologic platelet thrombus dissolution with short and long acting Glycoprotein IIBIIIA inhibitors are effective when administered locally or systemically. Raising cerebral perfusion pressure may augment collateral flow with consequent reduction in the risk of ischemic sequelae. Intra arterial or peripheral venous administration of GPIIBIIIA inhibitors upon identification of intraluminal thrombus may prevent progression to complete vascular occlusion. Minimal thrombus formation at the coil/parent vessel interface is often observed. Eptifibatide has a shorter half life (2-4 hours) and is advantageous over Abciximab in ruptured aneurysm that potentially require post procedural placement of a ventriculostomy. A fluid bolus followed by appropriate pharmacologic induction of increased blood pressure allows for augmentation of collateral vasculature. Vessel caliber change or limitation of flow may be consequent to vasospasm. This can be addressed by localized intra arterial calcium channel blocker administration.
{"title":"Management of Intraprocedural Adverse Events during coil embolization of cerebral aneurysms: A Clinical Case Series Review.","authors":"A. Gordhan","doi":"10.5580/1b9d","DOIUrl":"https://doi.org/10.5580/1b9d","url":null,"abstract":"The overall complication rate for endovascular coil embolization of cerebral aneurysms is 5% percent. This is an illustrative case series that describes management aspects and probable precipitants of adverse events during coil embolization and related imaging and clinical outcomes. Major intraprocedural intracranial adverse events during endovascular coil embolization of cerebral aneurysms can be divided into three categories. Thromboembolic, aneurysm or parent vessel perforations/ruptures and embolysate related. Clinical case examples with rescue intervention and outcomes are discussed within each category. 1) Thromboembolic (Case 1 and 2): This is the most frequent complication and cause of morbidity and mortality. Thromboembolic may occur consequent to failure of sustained and or sufficient systemic anticoagulation. Prevention of localized platelet and clotting cascade activation in the context of thrombogenic device introduction for coil embolization is vital in preventing partial or complete parent, branch or distal vessel occlusion. Embolic propagation of thrombus may arise from native vessel disease and or consequent to mechanical device manipulation during coil delivery and deployment, as well as with the use of adjuncts such as balloon assist. Frequent monitoring of ACT (Activated Clotting Time) values for systemic anticoagulation with Heparin to confirm twice the baseline value is the primary preventative method. Intraprocedural pharmacologic platelet thrombus dissolution with short and long acting Glycoprotein IIBIIIA inhibitors are effective when administered locally or systemically. Raising cerebral perfusion pressure may augment collateral flow with consequent reduction in the risk of ischemic sequelae. Intra arterial or peripheral venous administration of GPIIBIIIA inhibitors upon identification of intraluminal thrombus may prevent progression to complete vascular occlusion. Minimal thrombus formation at the coil/parent vessel interface is often observed. Eptifibatide has a shorter half life (2-4 hours) and is advantageous over Abciximab in ruptured aneurysm that potentially require post procedural placement of a ventriculostomy. A fluid bolus followed by appropriate pharmacologic induction of increased blood pressure allows for augmentation of collateral vasculature. Vessel caliber change or limitation of flow may be consequent to vasospasm. This can be addressed by localized intra arterial calcium channel blocker administration.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130475662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adeolu L. Olasunkanmi, Robert E. Elliott, Kia Newman, I. Mikolaenko, D. Zagzag, J. Golfinos
Background: Hemangioblastomas (HBs) are benign neoplasms of the central nervous system (CNS) that account for 10–15% of posterior fossa tumors in adults. HBs most commonly arise in the cerebellum but also occur in the spinal cord and medulla. They occur sporadically as solitary lesions or in association with von Hippel-Lindau (VHL) disease and are usually multiple. HBs can arise in the supratentorial space (>100 reported cases) but only 16 cases of pituitary stalk HBs have been reported—87.5% of which occurred in the setting of VHL disease. Although multiple, metachronous and disseminated HBs can occur in the setting of VHL disease, there are no reported cases of focal, metachronous HBs in patients without this disease. Case Description: We report the case of a 61-year old man with no personal or family history of VHL disease who presented with a pituitary stalk HB 9 years after complete resection of a cerebellar HB. He underwent complete resection complicated by diabetes insipidis and visual field deterioration.Conclusion: The occurrence of HB at different times and in disparate locations within the CNS is not synonymous with the diagnosis of VHL disease. While diffuse dissemination has been reported following surgery, this is the first reported case of a focal metachronous HBs arising in a patient without VHL disease. Although its unusual location within the pituitary stalk complicated the diagnosis preoperatively, a second HB should be considered in the differential diagnosis and close follow-up may be warranted to identify such lesions prior to irreversible neurological deficits.
{"title":"Metachronous Pituitary Stalk And Cerebellar Hemangioblastomas In A Patient Without Von Hippel-Lindau Disease: Case Report And Review Of Literature","authors":"Adeolu L. Olasunkanmi, Robert E. Elliott, Kia Newman, I. Mikolaenko, D. Zagzag, J. Golfinos","doi":"10.5580/2249","DOIUrl":"https://doi.org/10.5580/2249","url":null,"abstract":"Background: Hemangioblastomas (HBs) are benign neoplasms of the central nervous system (CNS) that account for 10–15% of posterior fossa tumors in adults. HBs most commonly arise in the cerebellum but also occur in the spinal cord and medulla. They occur sporadically as solitary lesions or in association with von Hippel-Lindau (VHL) disease and are usually multiple. HBs can arise in the supratentorial space (>100 reported cases) but only 16 cases of pituitary stalk HBs have been reported—87.5% of which occurred in the setting of VHL disease. Although multiple, metachronous and disseminated HBs can occur in the setting of VHL disease, there are no reported cases of focal, metachronous HBs in patients without this disease. Case Description: We report the case of a 61-year old man with no personal or family history of VHL disease who presented with a pituitary stalk HB 9 years after complete resection of a cerebellar HB. He underwent complete resection complicated by diabetes insipidis and visual field deterioration.Conclusion: The occurrence of HB at different times and in disparate locations within the CNS is not synonymous with the diagnosis of VHL disease. While diffuse dissemination has been reported following surgery, this is the first reported case of a focal metachronous HBs arising in a patient without VHL disease. Although its unusual location within the pituitary stalk complicated the diagnosis preoperatively, a second HB should be considered in the differential diagnosis and close follow-up may be warranted to identify such lesions prior to irreversible neurological deficits.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131824326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
IntroductionSurgery for vestibular schwannoma taxes the surgeon’s skill to the hilt especially in removing the tumor completely and preserving the facial nerve.Aims To study the anatomical and functional status of the facial nerve in patients after vestibular schwannoma surgery and analyze the factors contributing to the outcome after surgery.Materials and methodsA retrospective analysis of all the case records of patients operated for Vestibular Schwannoma from 1980 to December 2007 in Kasturba Hospital Manipal was done which included their pre operative facial nerve function and post operative anatomical and functional status. The data was analyzed and conclusions drawn.Results210 patients who underwent surgery for vestibular schwannoma were included. In 111 patients(53%) preoperative facial nerve deficit was present and graded by House and Brackman grading. 207 out of 210 patients were operated by suboccipital retromastoid route. In 138 patients anatomical preservation of facial nerve was done, of which 120 patients underwent internal auditory meatus drilling. The rate of anatomical preservation has increased from 10% in the initial part of the study period to 100% in the latter part. Overall, 82.8% of the patients had a good functional outcome and 17.2% had a worse functional state than their preoperative status. We had operative mortality of 2.5%ConclusionsAbility to preserve the facial nerve improves with number of cases. Transmeatal drilling helped in identifying and protecting the facial nerve. Majority of patients in our series have presented as large tumors (69%) inspite of which good functional outcome was achieved.
{"title":"Facial Nerve Preservation In Vestibular Schwannoma Surgery- Anatomical And Functional Status","authors":"J. Dil, S. Dil, G. Manoharan, A. Raja","doi":"10.5580/4ca","DOIUrl":"https://doi.org/10.5580/4ca","url":null,"abstract":"IntroductionSurgery for vestibular schwannoma taxes the surgeon’s skill to the hilt especially in removing the tumor completely and preserving the facial nerve.Aims To study the anatomical and functional status of the facial nerve in patients after vestibular schwannoma surgery and analyze the factors contributing to the outcome after surgery.Materials and methodsA retrospective analysis of all the case records of patients operated for Vestibular Schwannoma from 1980 to December 2007 in Kasturba Hospital Manipal was done which included their pre operative facial nerve function and post operative anatomical and functional status. The data was analyzed and conclusions drawn.Results210 patients who underwent surgery for vestibular schwannoma were included. In 111 patients(53%) preoperative facial nerve deficit was present and graded by House and Brackman grading. 207 out of 210 patients were operated by suboccipital retromastoid route. In 138 patients anatomical preservation of facial nerve was done, of which 120 patients underwent internal auditory meatus drilling. The rate of anatomical preservation has increased from 10% in the initial part of the study period to 100% in the latter part. Overall, 82.8% of the patients had a good functional outcome and 17.2% had a worse functional state than their preoperative status. We had operative mortality of 2.5%ConclusionsAbility to preserve the facial nerve improves with number of cases. Transmeatal drilling helped in identifying and protecting the facial nerve. Majority of patients in our series have presented as large tumors (69%) inspite of which good functional outcome was achieved.","PeriodicalId":326784,"journal":{"name":"The Internet Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123434779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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