gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Hemihypoglossal facial nerve anastomosis for facial nerve palsy

Meeting Abstract

  • P. Kunert - Department of Neurosurgery, Medical University of Warsaw, Poland
  • A. Podgorska - Department of Neurosurgery, Medical University of Warsaw, Poland
  • R. Bartoszewicz - Department of Otolaryngology, Medical University of Warsaw, Poland
  • K. Morawski - Department of Otolaryngology, Medical University of Warsaw, Poland
  • A. Marchel - Department of Neurosurgery, Medical University of Warsaw, Poland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.06.12

DOI: 10.3205/11dgnc145, URN: urn:nbn:de:0183-11dgnc1453

Published: April 28, 2011

© 2011 Kunert et al.
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Outline

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Objective: Despite a significant improvement in the results of cerebello-pontine angle tumor surgery in recent decades, facial nerve palsy still occurs, especially after large vestibular schwannoma removal. Commonly used classic hypoglossal to facial nerve anastomosis has the disadvantage of hemitongue atrophy. Thus, various attempts have been made to modify this method to reduce the damage to the tongue. The aim of this report is to present the results of the hemihypoglossal-facial nerve anastomosis technique in relation to facial muscles reanimation and hemitongue atrophy.

Methods: The first seven, consecutive patients, who underwent the facial nerve anastomosis with half of the hypoglossal nerve, in which the follow-up period exceeded 1 year, were analyzed. The cause of facial palsy was previous surgery for vestibular schwannoma in 6 cases and petroclival meningioma in 1. The series consisted of four women and three men, ranging in age from 28 to 62 years (average 51). Duration of facial palsy before surgery ranged from 1 to 22 months (average 10). In 3 cases of intraoperative facial nerve disruption, the anastomosis was performed as early as 1 month after surgery. The remaining patients with anatomically preserved facial nerves but with no signs of regeneration after next 6 months were operated on later. The procedure was performed similarly to the "end-to-side” technique described by Darrouzet but the only difference was that the hypoglossal nerve was divided longitudinally for a short distance to ensure the anastomosis without tension and without a sharp angle between the stumps. Recovery from facial palsy was quantified with the House-Brackmann (HB) grading system. Tongue atrophy and deviation were assessed according to scale proposed by Martins.

Results: Features of initial reinnervation of facial muscles were visible after six months in all 7 patients. All the patients achieved satisfactory outcome of the VII nerve regeneration (HB grade 3) until the last control examination (12–27 months after surgery, average 16). No or minimal tongue atrophy without deviating (grade I-II according to Martins scale) was found in 4 patients. Mild atrophy with tongue deviation <30 degrees (grade III) was visible in 3 patients and no patient developed severe hemitongue atrophy (grade IV).

Conclusions: In our experience, the hemihypoglossal-facial nerve anastomosis is an effective treatment of facial palsy and makes it possible to reduce damage of the tongue.