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Juguler foramen nörinomlarının tedavisinde konservatif fasyal sinir yaklaşımı

CONSERVATIVE FACIAL NERVE MANAGEMENT IN JUGULAR FORAMEN SCHWANNOMAS

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Abstract (2. Language): 
Objective: Although transposition of the facial nerve is crucial in infiltrative, vascular lesions involving the jugular foramen, it was our objective to show that a conservative approach to management of the facial nerve is sufficient in jugular foramen neuromas because of their non-infiltrative, less vascular nature and medial location in the jugular foramen. Patients: Sixteen patients with jugular foramen schwannoma were treated (18 procedures) between January, 1975 and October, 1995. The eight males and eight females ranged in age from 13 to 66 years, with a mean age of 47.7 years. Intervention: One-stage, total jugular foramen neuroma removal without transposition of the facial nerve, using a variety of surgical approaches. Main Outcome Measures: Facial nerve transposition (yes or no), House-Brackmann facial nerve grade, lower cranial nerve status, complications. Results: One stage total tumor removal was accomplished in all of the cases. In 13 (72%) of the neuromas, removal was accomplished without facial nerve transposition. Transpos t on was performed n two rev s on cases to control the carot d artery completely, two cases with large tumor extension anteriorly to the petrous apex and one case w th extens ve nvolvement of the m ddle ear. A House-Brackmann fac al nerve grade I or II was obtained in 16 of the 18 procedures, with one grade III and one case which remained grade 9, as it was preoperatively. Conclusions: One stage, total tumor removal can be achieved with excellent control of the mportant vascular structures and w thout transpos t on of the fac al nerve n the major ty of jugular foramen schwannomas.
Abstract (Original Language): 
Amaç: Juguler forameni tutan, infiltrative, vasküler lezyonların tedavisinde yeterli expojur için fasyal sinir transpozisyonu önemlidir. Bu çalışmadaki amacımız juguler foramen nörinomlarının vaskülaritesi az, non infiltratif ve juguler foramende medialde yerleşmes özell kler neden yle fasyal s n r transpoze etmeden tedav etmen n yeterl olacağını göstermektir. Hastalar: Ocak 1975 ile ekim 1995 arasında juguler foramen nörinomu nedeniyle tedav ed len 16 hasta (18 operasyon). Hastalar 8 erkek ve 8 kadın, 13 le 66 yaşları arasında idi, ortalama 47.7 yıl. Müdahele: Tek aşamalı fasyal siniri transpoze etmeden, çeşitli operasyonlarla total juguler foramen nörinomu eksizyonu. Ana değerlendirme kriterleri: Fasyal sinir traspozisyonu ( evet veya hayır), House-Brackmann fasyal sinir greydi, alt kranyal sinir durumu, komplikasyonlar. Bulgular: Tek aşamalı, tüm hastalarda total tümor eksizyonu gerçekleştirildi. On üç hastada (%72) fasyal siniri transpoze etmeden, juguler foramen nörinomu çıkartıldı. İki rev zyon vakada karot d arter tam kontrol ç n, d ğer olguda petroz apekse ulaşan çok büyük tümörlü iki hastada ve yaygın olarak orta kulağı tutan bir olguda transpozisyon uygulandı. On altı hastada House-Brackmann greyd 1 veya 2 fasyal sinir sonucu elde edildi, bir hasta da greyd 3, bir hastada preoperatif seviyesi olan greyd 5 olarak kaldı. Sonuç: Juguler foramen nörinomlarının tedavisinde, tek aşamalı olarak total tümor eks zyonu, fasyal s n r transpoze etmeden, vasküler yapıların mükemmel kontrolüyle yapılabilir.
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REFERENCES

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