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Identification of cranial nerves near large vestibular schwannomas using superselective diffusion tensor tractography: experience with 23 cases

  • Clinical Article - Brain Tumors
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Abstract

Background

The preservation of the facial nerve (FN) and acoustic function in large vestibular schwannoma (VS) surgery is challenging because of nerve course uncertainties and morphological deviations. Preoperative diffusion tensor tractography (DTT) has been proposed to predict the FN location. This study was conducted to evaluate the effectiveness of this technique for identifying the FN, cochlear nerve (CN) and trigeminal nerve (TN) in large VSs.

Methods

The study included 23 consecutive patients with VS of Hannover classification T3b to T4b from November 2013 through May 2014. Diffusion tensor images and anatomical images were acquired. The DTT images of the cranial nerves were extracted before surgery for each patient to determine the relationships of these nerves with the tumor. The results were then validated during the tumorectomy.

Results

In 21 (91.30 %) patients, the location of the FN on the DTT images agreed with the intraoperative findings, including in 2 patients in whom the FN passed through the interface between the parenchyma and the cystic changes and in 3 patients with a membranoid FN. The CN or fibers of unclear function were observed on DTT images in four patients with functional hearing. One penetrating fiber of unknown function was effectively constructed. The TN was accurately detected on the DTT images for all patients.

Conclusions

DTT effectively revealed the location of the FN, including cases in which the FN was membranoid or passed through the interface between an area exhibiting cystic changes and the tumor nodule. Fibers aside from the FN and the TN were revealed by DTT in patients who retained functional hearing. Penetrating fibers were also found using DTT. This technique can be useful during VS resection.

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Acknowledgments

This work was supported by the National High Technology Research and Development Program of China (grant no. 2013AA013803).

Declaration

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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None.

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Authors and Affiliations

  1. Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China

    Peng-Hu Wei, Ge Chen, Peng Hu, Ming-Chu Li, Jian-Tao Liang, Hong-Chuan Guo, Feng Ling & Yu-Hai Bao

  2. Department of Radiology, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China

    Zhi-Gang Qi

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  1. Peng-Hu Wei
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Corresponding authors

Correspondence to Feng Ling or Yu-Hai Bao.

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Further illustration of Fig. 4. The video shows the residual cyst after tumor resection, which pulsed with the heartbeat. The vein and FN fiber were identified on the surface of the cyst. (MPG 25828 kb)

Further illustration of Fig. 7. The main surgical procedures shown in this video are presented in the Fig. 7 legend. (MP4 68428 kb)

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Wei, PH., Qi, ZG., Chen, G. et al. Identification of cranial nerves near large vestibular schwannomas using superselective diffusion tensor tractography: experience with 23 cases. Acta Neurochir 157, 1239–1249 (2015). https://doi.org/10.1007/s00701-015-2431-7

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  • DOI: https://doi.org/10.1007/s00701-015-2431-7

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