Preoperative identification of facial nerve in vestibular schwannomas surgery using diffusion tensor tractography

Kyung-Sik Choi, Min-Su Kim, Hyeok-Gyu Kwon, Sung-Ho Jang, Oh-Lyong Kim, Kyung-Sik Choi, Min-Su Kim, Hyeok-Gyu Kwon, Sung-Ho Jang, Oh-Lyong Kim

Abstract

Objective: Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve.

Methods: We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system.

Results: Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year.

Conclusion: This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation.

Keywords: Diffusion tensor imaging; Facial nerve injury; Vestibular schwannomas.

Figures

Fig. 1
Fig. 1
Case 7 : facial nerve is located on the anteroinferior of the tumor surface. Case 9 : facial nerve is located on the anterior of the tumor surface. Case 11 : facial nerve is located on the posteroinferior of the tumor surface. A : The preoperative axial enhanced T1-weighted magnetic resonance image shows a vestibular schwannoma. B : The preoperative diffusion tensor imaging of facial nerve tractography. C : Intraoperative findings.

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