title: Hypoglossal-facial nerve 'side'-to-side neurorrhaphy using a predegenerated nerve autograft for facial palsy after removal of acoustic tumours at the cerebellopontine angle.
abstract: METHODS
  Hypoglossal-facial nerve (HN-FN) neurorrhaphy is a method commonly used to treat facial palsy when the proximal stump of the injured FN is unavailable. Since the classic HN-FN neurorrhaphy method that needs to section the injured FN is not suitable for incomplete facial palsy, we investigated a modified method that consists of HN-FN 'side'-to-side neurorrhaphy, retaining the remaining or spontaneously regenerated FN axons while preserving hemihypoglossal function.
  
  
  METHODS
  To improve axonal regeneration, we used for the first time a predegenerated sural autograft for performing HN-FN 'side'-to-side neurorrhaphy followed by postoperative facial exercise. We treated 12 patients who had experienced FN injury for 1-18 months as a result of acoustic tumour removal. All patients experienced facial grade V-VI paralysis according to the House-Brackmann scale, but their FN was anatomically preserved. No spontaneous facial reinnervation was detected before repair.
  
  
  RESULTS
  Although we did not perform fresh nerve grafts and HN-FN 'side'-to-end neurorrhaphy as controls for ethical reasons, the reparative outcomes after nerve reconstruction were remarkable: functional improvements were detected as soon as 3 months after repair, House-Brackmann grade II or III FN functions were achieved in five and four patients, respectively, and there were no apparent signs of synkinesis. The three patients who experienced less satisfactory outcomes had exhibited facial palsy for more than 1 year accompanied by muscle atrophy, consistent with a need for rapid surgical intervention.
  
  
  CONCLUSIONS
  Based on fundamental concepts and our experimental results, this new surgical method represents a major advance in the rehabilitation of FN injury.
  
  
  BACKGROUND
  JS2013-001-02.
authors.affiliation: Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Liwei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Dezhi
authors.initials: D
authors.lastname: Li
authors.affiliation: Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wan
authors.affiliation: Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Shuyu
authors.initials: S
authors.lastname: Hao
authors.affiliation: Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.
authors.forename: Shiwei
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Junting
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Qiao
authors.affiliation: Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.
authors.forename: Mingran
authors.initials: M
authors.lastname: Wang
authors.affiliation: Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.
authors.forename: Diya
authors.initials: D
authors.lastname: Su
authors.affiliation: UMR 788, INSERM and Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Schumacher
authors.affiliation: Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China UMR 788, INSERM and Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Song
authors.initials: S
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D002530:Cerebellopontine Angle / Q000601:surgery*; D004576:Electromyography; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D013497:Sural Nerve / Q000637:transplantation; D016896:Treatment Outcome; D055815:Young Adult
keywords: NEUROMUSCULAR; NEUROSURGERY; PERIPHERAL NERVE SURGERY; REHABILITATION