Factors associated with abducens nerve recovery in patients undergoing surgical resection of sixth nerve schwannoma: A systematic review and case illustration.

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Factors associated with abducens nerve recovery in patients undergoing surgical resection of sixth nerve schwannoma: A systematic review and case illustration.

World Neurosurg. 2017 Apr 29;:

Authors: Sun H, Sharma K, Kalakoti P, Thakur JD, Patra DP, Konar S, Maiti T, Akbarian-Tefaghi H, Bollam P, Notarianni C, Nanda A

Abstract
BACKGROUND: Limited or no literature exists identifying factors associated with functional nerve recovery in patients undergoing resection of sixth nerve (CN VI) schwannomas.
METHODS: A systematic review of literature was performed on CN VI schwannomas that were treated surgically. Synthesizing the findings pooled from the literature, we investigated associations of patient demographics and clinical characteristics with post-surgical CN VI functional recovery in multivariable regression models. Additionally, we present the findings of an adolescent woman surgically managed for intra-cavernous sixth nerve schwannoma. Complete encasement of the cavernous segment of the ICA is unique to our case.
RESULTS: We synthesized data of 32 patients from 29 publications, and our index case. Overall, the mean age of the patients was 44.0±16.5 years, and approximately 52% (n=17) were female. Most tumors were left-sided (n=18; 54.5%), with an average size of 3.46±1.71 cms. Most common location was cisternal (n=11; 33%), followed by cavernous sinus (CS) proper (n=9; 27%), cistero-cavernous (n=8; 24%), orbital (n=4; 12%) and caverno-orbital (n=1; 3%). CN VI recovery was reported in less than half the cohort (n=14; 45%). Tumor extension in the CS was significantly associated with lesser likelihood (OR: 0.07; 95% CI: 0.01-0.98; p=0.048) of post-surgical CN VI recovery. Although female gender (OR: 0.86; 95% CI: 0.07-10.09; p=0.906), large tumor size (>2.5 cms) (OR:0.45; 95% CI:0.07-2.89; p=0.397) and solid consistency (OR:0.37; 95% CI: 0.03-4.19; p=0.421) were associated with lesser odds for recovery, these were not statistically significant. Likewise, gross-total resection (OR:6.28; 95% CI:0.33-118.25; p=0.220) was associated with higher odds of nerve recovery, the estimates were statistically insignificant.
CONCLUSIONS: CS involvement is associated with lesser odds for functional nerve recovery in patients undergoing surgical resection for CN VI schwannoma.

PMID: 28465275 [PubMed - as supplied by publisher]

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