RESUMO
This study reviewed 124 patients who required facial nerve manipulation during cranial base surgery. Most of them underwent only nerve displacement or selective transection for improved surgical access to the cranial base (70 and 34, respectively). Fourteen patients had the facial nerve resected for oncologic reasons and repaired with primary nerve grafting. Most patients regained quite satisfactory facial function with quality correlating with the degree of nerve injury. Six patients had facial nerve resected as part of oncologic palliation and had the facial deficit rehabilitated with regional tissue. A correlation between preoperative facial nerve weakness and the quality of nerve graft function was not found. An oncologic correlation, however, is suggested (patients with preoperative weakness had less favorable prognosis). Overall, patients who require facial nerve resection for oncologic reasons do not do as well as those with normal preoperative function.
Assuntos
Nervo Facial/anatomia & histologia , Nervo Facial/cirurgia , Crânio/cirurgia , Estimulação Elétrica , Expressão Facial , Músculos Faciais/inervação , Músculos Faciais/fisiopatologia , Nervo Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Contração Muscular/fisiologia , Regeneração Nervosa , Transferência de Nervo , Crânio/inervação , Neoplasias Cranianas/patologia , Neoplasias Cranianas/cirurgia , Nervo Sural/transplante , Osso Temporal/inervação , Osso Temporal/cirurgiaRESUMO
During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Artérias Carótidas/transplante , Seio Cavernoso/cirurgia , Nervos Cranianos/transplante , Humanos , Estudos Retrospectivos , Doenças Vasculares/cirurgiaRESUMO
Facial translocation is a new approach which has been developed for surgical management of extensive lesions of the anterolateral cranial base, including the nasopharynx, sphenoid sinus, clivus, infratemporal fossa, superior orbital fissure, and cavernous sinus. Temporary displacement of the craniofacial skeleton allows direct, wide access to this complex anatomic area, while giving the surgeon a high degree of control over critical neural and vascular structures.