Use of DTT to Define Facial Nerve Position in Vestibular Schwannomas

 Acoustic Neuroma / Posted 6 months ago

Vestibular schwannomas (VS) arise from the vestibulocochlear (hearing and balance) nerve, located at the base of the brain. Although benign, VS can enlarge over time, resulting in debilitating symptoms; therefore, surgical removal is frequently offered. One significant risk of surgery is inadvertent injury to the facial nerve, which lies adjacent to the vestibulocochlear nerve. Currently, the nerve’s course is only revealed during surgical dissection and injury can cause permanent facial weakness. It would therefore be useful for the surgeon to know the course of the nerve before operating. To this end, a new MRI technique known as probabilistic diffusion tensor tractography (DTT) has shown potential in revealing the course of the facial nerve pre-operatively. However, its clinical reliability remains uncertain.

This study aims to investigate the reliability of DTT in identifying the course of the facial nerve preoperatively in patients undergoing surgery for VS.

The future benefit would be to enable surgeons to operate with more confidence and potentially reduce the chance of nerve injury.

The study will recruit adult patients due to have surgery for VS. The only change to the participants’ clinical pathways will be the addition of a DTT sequence to their pre-operative MRI scans (increasing scanning time by approximately 10 minutes)

  • Inclusion Criteria : Ages Eligible for Study: 18 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No
    • The capacity to understand the patient information sheet and the ability to provide written informed consent
    • >1.5cm extrameatal tumor determined to represent a vestibular schwannoma by preoperative imaging
    • HB grade I or II preoperatively
  • Exclusion Criteria :
    • Patients not meeting the above inclusion criteria
    • Standard contraindications to MRI
    • Previous cranial radiotherapy or previous surgery to the cerebellopontine angle cistern or IAM
  • Study end date : 27/06/2022
  • Wales-Based Study Contact : Please speak to your clinician
  • Principal Investigator : Principal Investigator: Steve Connor, FRCR Principal Investigator: Philip Touska, FRCR
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