title: Stitchless fibrin glue-aided facial nerve grafting after cerebellopontine angle schwannoma removal: technique and results in 15 cases.
abstract: OBJECTIVE
  To evaluate the results of facial nerve (FN) grafting using great auricular cable graft and fibrin glue without suturing to palliate FN disruption after removal of large cerebellopontine angle (CPA) vestibular schwannoma (VS) or facial nerve schwannoma (FNS). To assess whether tumor size and origin influenced the results.
  
  
  METHODS
  Retrospective review of all patients having undergone removal of FNS/VS and needing intraoperative FN repair between 2001 and 2011.
  
  
  METHODS
  FN was rehabilitated using great auricular nerve cable graft and fibrin glue (Tisseal) without stitching suture.
  
  
  METHODS
  All data recorded were reviewed to access age, sex, tumor type, and tumor size according to the Koos classification and presenting symptoms. FN function was evaluated preoperatively and at 18 months using the House-Brackmann (HB) grading system.
  
  
  RESULTS
  Among the 595 patients operated for CPA schwannomas in this period, 15 patients (2.5%) underwent FN repair, including 7 cases of FNS and 8 cases of VS. Tumor removal was total in all cases. FN recovery was HB3 in 13 cases (86.7%) and HB4 in 2. The mean time to the first clinical signs of facial reinnervation was 10 months (6-12 mo). No significant relation was found between postoperative facial function and tumor size or type, even if all cases of preoperative FP were noted in FNS.
  
  
  CONCLUSIONS
  Immediate FN reconstruction with fibrin glue-aided greater auricular nerve graft can effectively restore FN function with excellent outcomes. The results seem better than those observed by other authors using sutured grafts or delayed hypoglossal-facial nerve anastomosis.
authors.affiliation: *Department of Otolaryngology, Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil; †Department of Otolaryngology and Skull Base Surgery, and ‡Department of Neurosurgery, Pellegrin University Hospital, University Bordeaux Segalen, Bordeaux, France.
authors.forename: Danielle Seabra
authors.initials: DS
authors.lastname: Ramos
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnard
authors.forename: Valérie
authors.initials: V
authors.lastname: Franco-Vidal
authors.forename: Dominique
authors.initials: D
authors.lastname: Liguoro
authors.forename: Vincent
authors.initials: V
authors.lastname: Darrouzet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery*; D005154:Facial Nerve / Q000473:pathology / Q000637:transplantation*; D005155:Facial Nerve Diseases / Q000473:pathology / Q000601:surgery; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D015718:Fibrin Tissue Adhesive