Risk factors of facial nerve dysfunction after sporadic vestibular schwannoma resection - A narrative review with illustrative cases

Background: Amidst progressive improvement of microsurgical techniques, facial nerve (FN) dysfunction is one of the most common complications after vestibular schwannoma (VS) resection. The current study discusses the risk factors associated with FN dysfunction, preservation of FN, and the patient’s quality of life (QoL). In addition, the use of exoscope and FN outcomes was discussed. Method: We searched PubMed and Scopus using the search terms vestibular schwannoma, acoustic neuroma, risk factors, facial nerve dysfunction, and microsurgery. Linkage or association studies available in full text were analyzed regarding risk factors of FN dysfunction after sporadic VS resection. Results: We categorized risk factors for FN dysfunction into three groups: non-tumoral, tumoral, and surgical. Tumoral factors were identified as the most significant predictors of FN dysfunction, including large tumor size, tumor extension, FN adhesion, the presence of cystic lesions, and advanced tumor stage. Data regarding non-tumoral factors, such as age and sex, showed heterogeneity and inconsistency. While the middle cranial fossa (MCF) approach may lead to increased FN injury, it was not deemed a significant predictor of FN dysfunction. Furthermore, employing intraoperative monitoring of the FN was linked with improved FN outcomes. Conclusions: Our review indicates that mounting evidence supports the association of cystic lesions, large tumors, and tumor adhesion to the FN as critical predictors of adverse FN outcomes. When these risk factors necessitate partial resection, radiological follow-up is imperative to monitor for tumor recurrence and to determine the necessity of further surgical intervention

Supplemental Material - Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran

Supplemental Material for Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran by Arman Zeinaddini-Meymand, Vali Baigi, Mehdi Mousavi-Nasab, Sina Shool, Mohsen Sadeghi-Naini, Zahra Azadmanjir, Seyed Behnam Jazayeri, Samuel Berchi Kankam, Mohammad Dashtkoohi, Aidin Shakeri, Esmail Fakharian, Leila Kouchakinejad-Eramsadati, Habibollah Pirnejad, Homayoun Sadeghi-Bazargani, Laleh Bagheri, Yasaman Pourandish, Malihe Amiri, Ahmad Pour-Rashidi, James Harrop, and Vafa Rahimi-Movaghar in Global Spine Journal</p

Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran

PURPOSE: This study aimed to implement the Quality of Care (QoC) Assessment Tool from the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to map the current state of in-hospital QoC of individuals with Traumatic Spinal Column and Cord Injuries (TSCCI).METHODS: The QoC Assessment Tool, developed from a scoping review of the literature, was implemented in NSCIR-IR. We collected the required data from two primary sources. Questions regarding health system structures and care processes were completed by the registrar nurse reviewing the hospital records. Questions regarding patient outcomes were gathered through patient interviews.RESULTS: We registered 2812 patients with TSCCI over six years from eight referral hospitals in NSCIR-IR. The median length of stay in the general hospital and intensive care unit was four and five days, respectively. During hospitalization 4.2% of patients developed pressure ulcers, 83.5% of patients reported satisfactory pain control and none had symptomatic urinary tract infections. 100%, 80%, and 90% of SCI registration centers had 24/7 access to CT scans, MRI scans, and operating rooms, respectively. Only 18.8% of patients who needed surgery underwent a surgical operation in the first 24 h after admission. In-hospital mortality rate for patients with SCI was 19.3%.CONCLUSION: Our study showed that the current in-hospital care of our patients with TSCCI is acceptable in terms of pain control, structure and length of stay and poor regarding in-hospital mortality rate and timeliness. We must continue to work on lowering rates of pressure sores, as well as delays in decompression surgery and fatalities.</p