title: Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases.
abstract: OBJECTIVE The aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries. METHODS The authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system. RESULTS Two hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002). CONCLUSIONS Cable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue-aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.
authors.affiliation: 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.
authors.forename: Sampath Chandra
authors.initials: SC
authors.lastname: Prasad
authors.affiliation: 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Balasubramanian
authors.affiliation: 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.
authors.forename: Enrico
authors.initials: E
authors.lastname: Piccirillo
authors.affiliation: 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Taibah
authors.affiliation: 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Russo
authors.affiliation: 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.|2Department of Otorhinolaryngology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic ofChina.
authors.forename: Jingchun
authors.initials: J
authors.lastname: He
authors.affiliation: 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.
authors.forename: Mario
authors.initials: M
authors.lastname: Sanna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002528:Cerebellar Neoplasms / Q000601:surgery; D002530:Cerebellopontine Angle / Q000601:surgery; D002648:Child; D003390:Cranial Nerve Neoplasms / Q000601:surgery; D005154:Facial Nerve / Q000601:surgery*; D020220:Facial Nerve Injuries / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: CPA = cerebellopontine angle; FN = facial nerve; FNT = FN tumor; HB = House-Brackmann; House-Brackmann grading; IAC = internal auditory canal; PBC = petrous bone cholesteatoma; SN = sural nerve; TJP = tympanojugular paraganglioma; VS = vestibular schwannoma; cable nerve graft interpositioning; cerebellopontine angle; facial nerve; facial nerve tumor; peripheral nerve; skull base; sural nerve