Accuracy and outcomes of diffusion tensor imaging tractography in resection for vestibular schwannoma for facial nerve preservation

J Neurol Sci. 2021 Nov 15:430:120006. doi: 10.1016/j.jns.2021.120006. Epub 2021 Sep 25.

Abstract

Background: Impairment of facial nerve (FN) function is a common postoperative complication in surgical resections of Vestibular Schwannomas (VS). Diffusion tensor imaging (DTI) tractography creates in vivo imaging of the anatomical location of white matter tracts that can be preoperatively used to visualize the displaced FN. We present an analysis of patients who underwent DTI tractography imaging prior to VS resection.

Methods: Patient charts were reviewed from March 2012 to April 2015 who underwent DTI tractography prior to surgical resection for VS. Reliability of this measure was compared to the intraoperative FN location as determined by the surgeon. House Brackmann (HB) score was used to assess facial nerve function.

Results: A total of 11 patients were included with a mean age of 43 years (range: 19-64) and mean follow-up length of 11.9 months (range: 3.1-34.2). The average maximum tumor diameter was 2.82 cm (range: 1.7-4.2). DTI tractography was accurate in 90.9% (10/11) of patients. Postoperatively, 72.7% (8/11) had a HB score of I or II, 18.2% (2/11) had a HB score of III, and 9.1% (1/11) had a HB score of IV.

Conclusions: Facial nerve visualization for VS resection can be accurately visualized using DTI tractography. This modality may lead to reduction of postoperative FN damage.

Keywords: Brain tumor; Diffusion tensor imaging; Facial nerve; Vestibular schwannoma.

MeSH terms

  • Adult
  • Diffusion Tensor Imaging
  • Facial Nerve / diagnostic imaging
  • Facial Nerve / surgery
  • Facial Nerve Injuries* / etiology
  • Facial Nerve Injuries* / prevention & control
  • Humans
  • Neuroma, Acoustic* / diagnostic imaging
  • Neuroma, Acoustic* / surgery
  • Neurosurgical Procedures
  • Reproducibility of Results
  • Retrospective Studies
  • Treatment Outcome