Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function ...Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.展开更多
Guillain-Barré syndrome is a rare but fatal autoimmune disease of unknown origin. Infectious disease is the most common etiology of Guillain-Barré syndrome. We had a 75-year-old female patient with Guillain-...Guillain-Barré syndrome is a rare but fatal autoimmune disease of unknown origin. Infectious disease is the most common etiology of Guillain-Barré syndrome. We had a 75-year-old female patient with Guillain-Barré syndrome and a 90-year-old male patient with facial nerve palsy admitted to our hospital. Both patients experienced recovery from early Guillain-Barré syndrome and peripheral facial nerve palsy after receiving intravenous infusion of NaCl with KCl solution and taking vitamin C.展开更多
BACKGROUND:In the repair of nerve defects,collapse of the venous wall,as a result of vein grafting alone,could impede nerve regeneration.Therefore,vein lumens filled with muscle and nerve segments have been used to br...BACKGROUND:In the repair of nerve defects,collapse of the venous wall,as a result of vein grafting alone,could impede nerve regeneration.Therefore,vein lumens filled with muscle and nerve segments have been used to bridge nerve defects.OBJECTIVE:To compare the effects of autogenous,inside-out,vein-skeletal,muscle-combined grafting versus standard,vein-skeletal,muscle-combined grafting for the repair of facial nerve defects.DESIGN,TIME AND SETTING:A randomized,controlled,neuroanatomical,animal study was performed at the Animal Experimental Center and Laboratories of the Capital Medical University Xuanwu Hospital and the Peking Union Medical College Hospital from September 2007 to October 2008.MATERIALS:A total of 10 healthy,male,New Zealand rabbits,aged 6 months,were randomly assigned to inside-out,vein-skeletal,muscle-combined grafting and standard,vein-skeletal,muscle-combined grafting groups,with 5 rabbits in each group.METHODS:A 20-mm gap in the buccal branch of the right facial nerve was made in each animal,which was respectively repaired with inside-out,vein-skeletal,muscle-combined grafts or standard vein-skeletal muscle-combined grafts.MAIN OUTCOME MEASURES:At 6 months after implantation,evoked maximal compound muscle action potentials were recorded on bilateral facial nerves using electromyogram.Myelinated nerve fibers of the regenerating nerves were quantified using myelin sheath osmic acid staining.RESULTS:There was no significant difference between the groups in terms of ratios of bilateral amplitude and latency of compound muscle action potential(P>0.05).Moreover,morphology of regenerating nerves and quantity of myelinated nerve fibers were similar between the groups(P> 0.05).CONCLUTION:Compared with standard vein grafting,the inside-out vein grafting did not significantly improve nerve regeneration.Therefore,it is not necessary to utilize inside-out vein grafting for the repair of nerve defects,in particular with the combined use of autogenous vein and skeletal muscle grafts.展开更多
Although the transcriptional alterations inside the facial nucleus after facial nerve injury have been well studied,the gene expression changes in the facial nerve trunk after injury are still unknown.In this study,we...Although the transcriptional alterations inside the facial nucleus after facial nerve injury have been well studied,the gene expression changes in the facial nerve trunk after injury are still unknown.In this study,we established an adult rat model of facial nerve crush injury by compressing the right lateral extracranial nerve trunk.Transcriptome sequencing,differential gene expression analysis,and cluster analysis of the injured facial nerve trunk were performed,and 39 intersecting genes with significant variance in expression were identified.Gene Ontology annotation and Kyoto Encyclopedia of Genes and Genomes pathway analyses of the 39 intersecting genes revealed that these genes are mostly involved in leukocyte cell-cell adhesion and phagocytosis and have essential roles in regulating nerve repair.Quantitative real-time polymerase chain reaction assays were used to validate the expression of pivotal genes.Finally,nine pivotal genes that contribute to facial nerve recovery were identified,including Arhgap30,Akr1b8,C5ar1,Csf2ra,Dock2,Hcls1,Inpp5d,Sla,and Spi1.Primary Schwann cells were isolated from the sciatic nerve of neonatal rats.After knocking down Akr1b8 in Schwann cells with an Akr1b8-specific small interfering RNA plasmid,expression levels of monocyte chemoattractant protein-1 and interleukin-6 were decreased,while cell proliferation and migration were not obviously altered.These findings suggest that Akr1b8 likely regulates the interaction between Schwann cells and macrophages through regulation of cytokine expression to promote facial nerve regeneration.This study is the first to reveal a transcriptome change in the facial nerve trunk after facial nerve injury,thereby revealing the potential mechanism underlying repair of facial nerve injury.This study was approved by the Animal Ethics Committee of Nantong University,China in 2018(approval No.S20180923-007).展开更多
Immunobiological study is a key to revealing the important basis of facial nerve repair and regeneration for both research and development of clinic treatments. The microenvironmental changes around an injuried facial...Immunobiological study is a key to revealing the important basis of facial nerve repair and regeneration for both research and development of clinic treatments. The microenvironmental changes around an injuried facial motoneuron, i.e., the aggregation and expression of various types of immune cells and molecules in a dynamic equilibrium, impenetrate from the start to the end of the repair of an injured facial nerve. The concept of "immune microenvironment for facial nerve repair and regeneration", mainly concerns with the dynamic exchange between expression and regulation networks and a variaty of immune cells and immune molecules in the process of facial nerve repair and regeneration for the maintenance of a immune microenvironment favorable for nerve repair. Investigation on microglial activation and recruitment, T cell behavior, cytokine networks, and immunological cellular and molecular signaling pathways in facial nerve repair and regeneration are the current hot spots in the research on immunobiology of facial nerve injury. The current paper provides a comprehensive review of the above mentioned issues. Research of these issues will eventually make immunological interventions practicable treatments for facial nerve injury in the clinic.展开更多
Acellular nerve allografts conducted via chemical extraction have achieved satisfactory results in bridging whole facial nerve defects clinically,both in terms of branching a single trunk and in connecting multiple br...Acellular nerve allografts conducted via chemical extraction have achieved satisfactory results in bridging whole facial nerve defects clinically,both in terms of branching a single trunk and in connecting multiple branches of an extratemporal segment.However,in the clinical treatment of facial nerve defects,allogeneic donors are limited.In this experiment,we exposed the left trunk and multiple branches of the extratemporal segment in six rhesus monkeys and dissected a gap of 25 mm to construct a monkey model of a whole left nerve defect.Six monkeys were randomly assigned to an autograft group or a xenogeneic acellular nerve graft group.In the autograft group,the 25-mm whole facial nerve defect was immediately bridged using an autogenous ipsilateral great auricular nerve,and in the xenogeneic acellular nerve graft group,this was done using a xenogeneic acellular nerve graft with trunk-branches.Examinations of facial symmetry,nerve-muscle electrophysiology,retrograde transport of labeled neuronal tracers,and morphology of the regenerated nerve and target muscle at 8 months postoperatively showed that the faces of the monkey appeared to be symmetrical in the static state and slightly asymmetrical during facial movement,and that they could actively close their eyelids completely.The degree of recovery from facial paralysis reached House-Brackmann grade II in both groups.Compound muscle action potentials were recorded and orbicularis oris muscles responded to electro-stimuli on the surgical side in each monkey.Fluoro Gold-labeled neurons could be detected in the facial nuclei on the injured side.Immunohistochemical staining showed abundant neurofilament-200-positive axons and soluble protein-100-positive Schwann cells in the regenerated nerves.A large number of mid-graft myelinated axons were observed via methylene blue staining and a transmission electron microscope.Taken together,our data indicate that xenogeneic acellular nerve grafts from minipigs are safe and effective for repairing whole facial nerve defects in rhesus monkeys,with an effect similar to that of autologous nerve transplantation.Thus,a xenogeneic acellular nerve graft may be a suitable choice for bridging a whole facial nerve defect if no other method is available.The study was approved by the Laboratory Animal Management Committee and the Ethics Review Committee of the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University,China(approval No.2018-D-1)on March 15,2018.展开更多
Objective To investigate T cell activation following facial nerve axotomization and latent neuroimmunologic mechanisms in traumatic facial paralysis.Methods A murine model of facial nerve transaction was used.Lymphocy...Objective To investigate T cell activation following facial nerve axotomization and latent neuroimmunologic mechanisms in traumatic facial paralysis.Methods A murine model of facial nerve transaction was used.Lymphocytes from cervical and mesenteric lymph nodes in BABL/c mice at specific times were collected and expression rates of CD69 on T cells were assessed by flow cytometry.Results Infiltrating T cells were detected around the facial neurons in the facial nerve nucleus in mice whose facial nerve was transected.Immunofluorescent staining showed recruitment of activated T cells.Three days post-facial nerve transection,the expression rate of CD69 on T cells from cervical draining lymphoid nodes(CDLNs) was significantly different from that on T cells from mesenteric lymph nodes(MLNs)(P =0.0457),whereas the latter was similar to that in animals undergoing sham surgeries and that in blank control animals(p= 0.2817 and 0.2724,respectively).Two weeks post-nerve transection,the T cell CD69 expression rate from CDLNs remained at a higher level and than that in the sham-operation animals(p= 0.0007).At two weeks,CD69 expression rate on T cells from MLNs was also up-regulated and different compared with the sham-operation animals and with itself at three days post-operation(p= 0.0082 and 0.0133,respectively).Conclusion T cells appear to be activated and up-regulated in CDLNs following facial nerve transection.There is even evidence of T cell activation in MLNs at 2 weeks post-nerve transection.This suggestes an alteration of immune response from local to general immunity in the acute stage of facial nerve trauma,which may help coordinating and controlling the scales and orientation of the neuroimmune response during the pathogenesis and progression of facial nerve trauma.展开更多
Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advanc...Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advances in endoscopic surgery may consolidate the management plan for this condition.Methods: This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach(TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group.Outcome: The main outcome was facial function improvement, assessed using the House Brackmann grading scale(HBGS) 6 months after surgery, and hearing state assessed using the air bone gap(ABG).Results: The study included 38 patients, of whom 15 underwent had surgical decompression and 23underwent conservative therapy. A significant improvement in facial nerve function from a mean of4.66 ± 0.97 to 1.71 ± 0.69(P = 0.001) and ABG from a median of 30(10-40) to 20(10-25)(P = 0.002)was observed.Conclusion: Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.展开更多
BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graf...BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth,spreading,myelinization,in addition to limiting fibrotic degeneration after surgery.However,the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIM To investigate the histological,neurophysiological,and functional outcomes in facial reanimation using SC,compared to autograft.METHODS Our study is a systematic review of the literature,consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines.The review question was:In facial nerve reanimation on rats,has the use of stem cells revealed as effective when compared to autograft,in terms of histological,neurophysiological,and functional outcomes?Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTS After screening 148 manuscript,five papers were included in our study.43 subjects were included in the SC group,while 40 in the autograft group.The meta-analysis showed no significative differences between the two groups in terms of myelin thickness[CI:-0.10(-0.20,0.00);I^(2)=29%;P=0.06],nerve fibers diameter[CI:0.72(-0.93,3.36);I^(2)=72%;P=0.6],compound muscle action potential amplitude[CI:1.59(0.59,3.77);I^(2)=89%;P=0.15]and latency[CI:0.66(-1.01,2.32);I^(2)=67%;P=0.44].The mean axonal diameter was higher in the autograft group[CI:0.94(0.60,1.27);I^(2)=0%;P≤0.001].CONCLUSION The role of stem cells in facial reanimation is still relatively poorly studied,in animal models,and available results should not discourage their use in future studies on human subjects.展开更多
Dear Editor,Evidence of oculomotor nerve(ON)synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of sy...Dear Editor,Evidence of oculomotor nerve(ON)synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,compressive neoplasms,cavernous sinus展开更多
<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:""><span style="font-family:Verdana;">The surgery of cerebel...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:""><span style="font-family:Verdana;">The surgery of cerebellopontine angle tumours has remarkably progressed over the last 2 decades due to improved microsurgical techniques. </span><span style="font-family:Verdana;">The primary operative goals are microscopic total removal of the tumour</span><span style="font-family:Verdana;"> while securing the adjacent cranial nerves. Facial Nerve plays a critical role in facial muscles function and one’s cosmetic appearance, and its weakness can have </span><span><span style="font-family:Verdana;">profound implications on a patient’s quality of life. </span><b><span style="font-family:Verdana;">Aim of the Study: </span></b><span style="font-family:Verdana;">To </span></span><span style="font-family:Verdana;">assess </span><span style="font-family:Verdana;">the impact of monitoring techniques on the preservation of facial nerve</span><span style="font-family:Verdana;"> function during cerebellopontine angle tumours surgery. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">This is a prospective study. This study was conducted on 30 cases (2 groups, </span><span style="font-family:Verdana;">each had 15 patients) with CPA lesions that had undergone surgical exci</span><span style="font-family:Verdana;">sion of these lesions performed by retrosigmoid approach (Group A: the</span><span style="font-family:Verdana;"> pa</span><span style="font-family:Verdana;">tients were operated under continuous intraoperative facial nerve</span><span style="font-family:Verdana;"> monitoring</span> <span style="font-family:Verdana;">(IOFNM) and Group B: the patients were operated without IOFNM). They</span> <span style="font-family:Verdana;">were operated upon in neurosurgery departments at Al-Azhar university</span><span style="font-family:Verdana;"> hosp</span><span><span style="font-family:Verdana;">itals between August 2019 and August 2021. </span><b><span style="font-family:Verdana;">Results: </span></b></span></span><span style="font-family:Verdana;">This study sho</span><span style="font-family:Verdana;">wed that </span><span style="font-family:Verdana;">excellent facial nerve function (HB Grade I and II) was higher in group A</span><span style="font-family:""><span style="font-family:Verdana;"> than group B, immediately and at 6-month post op (80% and 93% VS 53.3% and 66.7%). Intermediate (HB Grade III and VI) and Poor (HB Grade V and </span><span style="font-family:Verdana;">VI) facial nerve function was higher in group B than group A;both</span><span style="font-family:Verdana;"> immediately and 6-month postop (46.7% and 33.3% VS 20% and 6.6%). However, </span><span><span style="font-family:Verdana;">no statistically significant P-Value between both groups. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We</span></span><span style="font-family:Verdana;"> concluded that IOFNM can help, but cannot guarantee, the preservation of facial </span><span style="font-family:Verdana;">nerve. Furthermore, it is merely a technical adjunct and does not replace</span><span style="font-family:Verdana;"> surgical skills, knowledge of anatomy and experience.展开更多
Objective: To identify the facial nerve trunk (FNT) very easily. quickly and accurately considering the styloid process as the robust anatomically consistent landmark during parotid surgery. Patients and Methods: This...Objective: To identify the facial nerve trunk (FNT) very easily. quickly and accurately considering the styloid process as the robust anatomically consistent landmark during parotid surgery. Patients and Methods: This prospective study was conducted between January 2010 to December 2022 at a Tertiary care hospital. It included 130 patients: 84 (65%) males and 46 (35%) females with a mean age of 43.52 ± 15.63 years. Patients presented with pleomorphic adenoma (90), chronic sialectasis (05), parotid cyst (03), parotid sinus (01), mucoepidermoid carcinoma (28), adenoid cystic carcinoma (02) and squamous cell carcinoma (01) were subjected to superficial parotidectomy and total parotidectomy. The outcome was evaluated regarding the clinical success of facial nerve function that considered the location of the styloid process in the triangle technique for identification of the FNT during parotid surgery. Results: All 130 patients underwent superficial and total parotidectomy. The facial nerve trunk was successfully identified as the location of the styloid process in the triangle technique in all the patients with no intra-operative complications. Operative time ranged from 50 to 180 minutes with a mean time 90.70 ± 15.68 minutes. Dysfunction of the angle of the mouth due to the deficit of the marginal mandibular nerve (MMN) was noted in 5 patients (3.8%), 02 had difficulty in eye closure (1.5%). No patient reported surgical site infection, skin flap necrosis and hematoma in this series. Conclusion: Styloid process is the prominent robust landmark in the triangle technique for the identification of facial nerve trunk with relative ease, safety and accuracy in the parotid surgical procedure. This can be a very useful method to locate the FNT and minimize facial nerve injury during parotid surgery.展开更多
Objective To study influence of distal portion compression of facial nerve in hemifacial spasm surgery. Methods 120 hemifacial spasm patients were undergone lateral spread response monitoring during microvascular deco...Objective To study influence of distal portion compression of facial nerve in hemifacial spasm surgery. Methods 120 hemifacial spasm patients were undergone lateral spread response monitoring during microvascular decompression surgery. 39 patients’LSR remained after decompression of the root exit zone of the facial nerve.展开更多
Objective To evaluate the long-term facial nerve funtion of patients following microsurgical removal of large and huge acoustic neuroma,and to indentify the factors that influence these outcomes. Methods A retrospecti...Objective To evaluate the long-term facial nerve funtion of patients following microsurgical removal of large and huge acoustic neuroma,and to indentify the factors that influence these outcomes. Methods A retrospective review was performed,which included 176 consecutive patients with a展开更多
Objective:To explore the mechanism of electroacupuncture(EA) in promoting recovery of the facial function with the involvement of autophagy,glial cell line-derived neurotrophic factor(GDNF),and phosphatidylinositol-3-...Objective:To explore the mechanism of electroacupuncture(EA) in promoting recovery of the facial function with the involvement of autophagy,glial cell line-derived neurotrophic factor(GDNF),and phosphatidylinositol-3-kinase(PI3K)/mammalian target of rapamycin(mTOR) signaling pathway.Methods:Seventy-two male Sprague-Dawley rats were randomly allocated into the control,sham-operated,facial nerve injury(FNI),EA,EA+3-methyladenine(3-MA),and EA+GDNF antagonist groups using a random number table,with 12 rats in each group.An FNI rat model was established with facial nerve crushing method.EA intervention was conducted at Dicang(ST 4),Jiache(ST 6),Yifeng(SJ 17),and Hegu(LI 4) acupoints for 2 weeks.The Simone’s 10-Point Scale was utilized to monitor the recovery of facial function.The histopathological evaluation of facial nerves was performed using hematoxylin-eosin(HE) staining.The levels of Beclin-1,light chain 3(LC3),and P62 were detected by immunohistochemistry(IHC),immunofluorescence,and reverse transcriptionpolymerase chain reaction,respectively.Additionally,IHC was also used to detect the levels of GDNF,Rai,PI3K,and mTOR.Results:The facial functional scores were significantly increased in the EA group than the FNI group(P<0.05 or P<0.01).HE staining showed nerve axons and myelin sheaths,which were destroyed immediately after the injury,were recovered with EA treatment.The expressions of Beclin-1 and LC3 were significantly elevated and the expression of P62 was markedly reduced in FNI rats(P<0.01);however,EA treatment reversed these abnormal changes(P<0.01).Meanwhile,EA stimulation significantly increased the levels of GDNF,Rai,PI3K,and mTOR(P<0.01).After exogenous administration with autophagy inhibitor 3-MA or GDNF antagonist,the repair effect of EA on facial function was attenuated(P<0.05 or P<0.01).Conclusions:EA could promote the recovery of facial function and repair the facial nerve damages in a rat model of FNI.EA may exert this neuroreparative effect through mediating the release of GDNF,activating the PI3K/mTOR signaling pathway,and further regulating the autophagy of facial nerves.展开更多
Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thy...Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.展开更多
Accurate localization of cranial nerves and responsible blood vessels is important for diagnosing trigeminal neuralgia(TN)and hemifacial spasm(HFS).Manual delineation of the nerves and vessels on medical images is tim...Accurate localization of cranial nerves and responsible blood vessels is important for diagnosing trigeminal neuralgia(TN)and hemifacial spasm(HFS).Manual delineation of the nerves and vessels on medical images is time-consuming and labor-intensive.Due to the development of convolutional neural networks(CNNs),the performance of medical image segmentation has been improved.In this work,we investigate the plans for automated segmentation of cranial nerves and responsible vessels for TN and HFS,which has not been comprehensively studied before.Different inputs are given to the CNN to find the best training configuration of segmenting trigeminal nerves,facial nerves,responsible vessels and brainstem,including the image modality and the number of segmentation targets.According to multiple experiments with seven training plans,we suggest training with the combination of three-dimensional fast imaging employing steady-state acquisition(3D-FIESTA)and three-dimensional time-of-flight magnetic resonance angiography(3DTOF-MRA),and separate segmentation of cranial nerves and vessels.展开更多
The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatroge...The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.展开更多
Facial synkinesis is a troublesome sequelae of facial nerve malfunction.It is difficult to recover from synkinesis,despite improved surgical techniques for isolating the peripheral facial nerve branches.Furthermore,it...Facial synkinesis is a troublesome sequelae of facial nerve malfunction.It is difficult to recover from synkinesis,despite improved surgical techniques for isolating the peripheral facial nerve branches.Furthermore,it remains unclear whether long-term dysfunction of motor control can lead to irreversible plasticity-induced structural brain changes.This case-control study thus investigated the structural brain alterations associated with facial synkinesis.The study was conducted at Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China.Twenty patients with facial synkinesis(2 male and 18 female,aged 33.35±6.97 years)and 19 healthy volunteers(2 male and 17 female,aged 33.21±6.75 years)underwent magnetic resonance imaging,and voxel-based and surface-based morphometry techniques were used to analyze data.There was no significant difference in brain volume between patients with facial synkinesis and healthy volunteers.Patients with facial synkinesis exhibited a significantly reduced cortical thickness in the contralateral superior and inferior temporal gyri and a reduced sulcal depth of the ipsilateral precuneus compared with healthy volunteers.In addition,sulcal depth of the ipsilateral precuneus was negatively correlated with the severity of depression.These findings suggest that there is a structural remodeling of gray matter in patients with facial synkinesis after facial nerve malfunction.This study was approved by the Ethics Review Committee of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China(approval No.2017-365-T267)on September 13,2017,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR1800014630)on January 25,2018.展开更多
BACKGROUND Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed,raising public concerns regarding the side effects of immunization,as the incidence of ...BACKGROUND Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed,raising public concerns regarding the side effects of immunization,as the incidence of ease.Although many adverse events following the coronavirus disease 2019(COVID-19)vaccine have been reported,neurological complications are relatively uncommon.Herein,we report a rare case of multiple cranial palsies following COVID-19 vaccination in an adolescent patient.CASE SUMMARY A previously healthy,14-year-old Asian girl with facial palsy presented to the emergency department with inability to close the right eye or wrinkle right side of the forehead,and pain in the right cheek.She had received second dose of the COVID-19 mRNA vaccine(Pfizer-BioNTech)18 days before onset of symptoms.She was diagnosed with Bell’s palsy and prescribed a steroid(1 mg/kg/day methylprednisolone)based on symptoms and magnetic resonance imaging findings.However,the next day,all sense of taste was lost with inability to swallow solid food;the gag reflex was absent.Horizontal diplopia was also present.Due to worsening of her condition,she was given high-dose steroids(1g/day methylprednisolone)for 3 days and then discharged with oral steroids.Improvement in the symptoms was noted 4 days post steroid treatment completion.At the most recent follow-up,her general condition was good with no symptoms except diplopia;ocular motility disturbances were noted.Hence,prism glasses were prescribed for diplopia relief.CONCLUSION Small-angle exotropia was observed in the facial,trigeminal,and glossopharyngeal nerve palsies,in our patient.The etiology of this adverse effect following vaccination was thought to be immunological.展开更多
文摘Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.
文摘Guillain-Barré syndrome is a rare but fatal autoimmune disease of unknown origin. Infectious disease is the most common etiology of Guillain-Barré syndrome. We had a 75-year-old female patient with Guillain-Barré syndrome and a 90-year-old male patient with facial nerve palsy admitted to our hospital. Both patients experienced recovery from early Guillain-Barré syndrome and peripheral facial nerve palsy after receiving intravenous infusion of NaCl with KCl solution and taking vitamin C.
基金the Postdoctoral Science Foundation of China,No.20070420402
文摘BACKGROUND:In the repair of nerve defects,collapse of the venous wall,as a result of vein grafting alone,could impede nerve regeneration.Therefore,vein lumens filled with muscle and nerve segments have been used to bridge nerve defects.OBJECTIVE:To compare the effects of autogenous,inside-out,vein-skeletal,muscle-combined grafting versus standard,vein-skeletal,muscle-combined grafting for the repair of facial nerve defects.DESIGN,TIME AND SETTING:A randomized,controlled,neuroanatomical,animal study was performed at the Animal Experimental Center and Laboratories of the Capital Medical University Xuanwu Hospital and the Peking Union Medical College Hospital from September 2007 to October 2008.MATERIALS:A total of 10 healthy,male,New Zealand rabbits,aged 6 months,were randomly assigned to inside-out,vein-skeletal,muscle-combined grafting and standard,vein-skeletal,muscle-combined grafting groups,with 5 rabbits in each group.METHODS:A 20-mm gap in the buccal branch of the right facial nerve was made in each animal,which was respectively repaired with inside-out,vein-skeletal,muscle-combined grafts or standard vein-skeletal muscle-combined grafts.MAIN OUTCOME MEASURES:At 6 months after implantation,evoked maximal compound muscle action potentials were recorded on bilateral facial nerves using electromyogram.Myelinated nerve fibers of the regenerating nerves were quantified using myelin sheath osmic acid staining.RESULTS:There was no significant difference between the groups in terms of ratios of bilateral amplitude and latency of compound muscle action potential(P>0.05).Moreover,morphology of regenerating nerves and quantity of myelinated nerve fibers were similar between the groups(P> 0.05).CONCLUTION:Compared with standard vein grafting,the inside-out vein grafting did not significantly improve nerve regeneration.Therefore,it is not necessary to utilize inside-out vein grafting for the repair of nerve defects,in particular with the combined use of autogenous vein and skeletal muscle grafts.
文摘Although the transcriptional alterations inside the facial nucleus after facial nerve injury have been well studied,the gene expression changes in the facial nerve trunk after injury are still unknown.In this study,we established an adult rat model of facial nerve crush injury by compressing the right lateral extracranial nerve trunk.Transcriptome sequencing,differential gene expression analysis,and cluster analysis of the injured facial nerve trunk were performed,and 39 intersecting genes with significant variance in expression were identified.Gene Ontology annotation and Kyoto Encyclopedia of Genes and Genomes pathway analyses of the 39 intersecting genes revealed that these genes are mostly involved in leukocyte cell-cell adhesion and phagocytosis and have essential roles in regulating nerve repair.Quantitative real-time polymerase chain reaction assays were used to validate the expression of pivotal genes.Finally,nine pivotal genes that contribute to facial nerve recovery were identified,including Arhgap30,Akr1b8,C5ar1,Csf2ra,Dock2,Hcls1,Inpp5d,Sla,and Spi1.Primary Schwann cells were isolated from the sciatic nerve of neonatal rats.After knocking down Akr1b8 in Schwann cells with an Akr1b8-specific small interfering RNA plasmid,expression levels of monocyte chemoattractant protein-1 and interleukin-6 were decreased,while cell proliferation and migration were not obviously altered.These findings suggest that Akr1b8 likely regulates the interaction between Schwann cells and macrophages through regulation of cytokine expression to promote facial nerve regeneration.This study is the first to reveal a transcriptome change in the facial nerve trunk after facial nerve injury,thereby revealing the potential mechanism underlying repair of facial nerve injury.This study was approved by the Animal Ethics Committee of Nantong University,China in 2018(approval No.S20180923-007).
文摘Immunobiological study is a key to revealing the important basis of facial nerve repair and regeneration for both research and development of clinic treatments. The microenvironmental changes around an injuried facial motoneuron, i.e., the aggregation and expression of various types of immune cells and molecules in a dynamic equilibrium, impenetrate from the start to the end of the repair of an injured facial nerve. The concept of "immune microenvironment for facial nerve repair and regeneration", mainly concerns with the dynamic exchange between expression and regulation networks and a variaty of immune cells and immune molecules in the process of facial nerve repair and regeneration for the maintenance of a immune microenvironment favorable for nerve repair. Investigation on microglial activation and recruitment, T cell behavior, cytokine networks, and immunological cellular and molecular signaling pathways in facial nerve repair and regeneration are the current hot spots in the research on immunobiology of facial nerve injury. The current paper provides a comprehensive review of the above mentioned issues. Research of these issues will eventually make immunological interventions practicable treatments for facial nerve injury in the clinic.
基金financially supported by the National Natural Science Foundation of China,No.81770990(to GCZ)Jiangsu Provincial Key Research and Development Program of China,No.BE2018628(to GCZ)+2 种基金Six Talent Peaks Project in Jiangsu Province of China,No.2019-WSW-141(to GCZ)Major Medicine Projects of Wuxi Health Commission of Jiangsu,China,No.Z201802(to DJX)Precision Medicine Projects of Wuxi Health Commission of Jiangsu,China,No.J202002(to GCZ)。
文摘Acellular nerve allografts conducted via chemical extraction have achieved satisfactory results in bridging whole facial nerve defects clinically,both in terms of branching a single trunk and in connecting multiple branches of an extratemporal segment.However,in the clinical treatment of facial nerve defects,allogeneic donors are limited.In this experiment,we exposed the left trunk and multiple branches of the extratemporal segment in six rhesus monkeys and dissected a gap of 25 mm to construct a monkey model of a whole left nerve defect.Six monkeys were randomly assigned to an autograft group or a xenogeneic acellular nerve graft group.In the autograft group,the 25-mm whole facial nerve defect was immediately bridged using an autogenous ipsilateral great auricular nerve,and in the xenogeneic acellular nerve graft group,this was done using a xenogeneic acellular nerve graft with trunk-branches.Examinations of facial symmetry,nerve-muscle electrophysiology,retrograde transport of labeled neuronal tracers,and morphology of the regenerated nerve and target muscle at 8 months postoperatively showed that the faces of the monkey appeared to be symmetrical in the static state and slightly asymmetrical during facial movement,and that they could actively close their eyelids completely.The degree of recovery from facial paralysis reached House-Brackmann grade II in both groups.Compound muscle action potentials were recorded and orbicularis oris muscles responded to electro-stimuli on the surgical side in each monkey.Fluoro Gold-labeled neurons could be detected in the facial nuclei on the injured side.Immunohistochemical staining showed abundant neurofilament-200-positive axons and soluble protein-100-positive Schwann cells in the regenerated nerves.A large number of mid-graft myelinated axons were observed via methylene blue staining and a transmission electron microscope.Taken together,our data indicate that xenogeneic acellular nerve grafts from minipigs are safe and effective for repairing whole facial nerve defects in rhesus monkeys,with an effect similar to that of autologous nerve transplantation.Thus,a xenogeneic acellular nerve graft may be a suitable choice for bridging a whole facial nerve defect if no other method is available.The study was approved by the Laboratory Animal Management Committee and the Ethics Review Committee of the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University,China(approval No.2018-D-1)on March 15,2018.
基金supported by grants from the National "Tenth-Five" Scientific & Technological Problem-Tackling Project(№:2004BA720A18-01)Social Welfare Foundation of Scientific Research Institutes of Chinese Ministry of Science & Technology(№:2002DB40097)
文摘Objective To investigate T cell activation following facial nerve axotomization and latent neuroimmunologic mechanisms in traumatic facial paralysis.Methods A murine model of facial nerve transaction was used.Lymphocytes from cervical and mesenteric lymph nodes in BABL/c mice at specific times were collected and expression rates of CD69 on T cells were assessed by flow cytometry.Results Infiltrating T cells were detected around the facial neurons in the facial nerve nucleus in mice whose facial nerve was transected.Immunofluorescent staining showed recruitment of activated T cells.Three days post-facial nerve transection,the expression rate of CD69 on T cells from cervical draining lymphoid nodes(CDLNs) was significantly different from that on T cells from mesenteric lymph nodes(MLNs)(P =0.0457),whereas the latter was similar to that in animals undergoing sham surgeries and that in blank control animals(p= 0.2817 and 0.2724,respectively).Two weeks post-nerve transection,the T cell CD69 expression rate from CDLNs remained at a higher level and than that in the sham-operation animals(p= 0.0007).At two weeks,CD69 expression rate on T cells from MLNs was also up-regulated and different compared with the sham-operation animals and with itself at three days post-operation(p= 0.0082 and 0.0133,respectively).Conclusion T cells appear to be activated and up-regulated in CDLNs following facial nerve transection.There is even evidence of T cell activation in MLNs at 2 weeks post-nerve transection.This suggestes an alteration of immune response from local to general immunity in the acute stage of facial nerve trauma,which may help coordinating and controlling the scales and orientation of the neuroimmune response during the pathogenesis and progression of facial nerve trauma.
文摘Objective: The management of traumatic facial nerve paralysis(FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management.However, recent advances in endoscopic surgery may consolidate the management plan for this condition.Methods: This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach(TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group.Outcome: The main outcome was facial function improvement, assessed using the House Brackmann grading scale(HBGS) 6 months after surgery, and hearing state assessed using the air bone gap(ABG).Results: The study included 38 patients, of whom 15 underwent had surgical decompression and 23underwent conservative therapy. A significant improvement in facial nerve function from a mean of4.66 ± 0.97 to 1.71 ± 0.69(P = 0.001) and ABG from a median of 30(10-40) to 20(10-25)(P = 0.002)was observed.Conclusion: Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.
文摘BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth,spreading,myelinization,in addition to limiting fibrotic degeneration after surgery.However,the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIM To investigate the histological,neurophysiological,and functional outcomes in facial reanimation using SC,compared to autograft.METHODS Our study is a systematic review of the literature,consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines.The review question was:In facial nerve reanimation on rats,has the use of stem cells revealed as effective when compared to autograft,in terms of histological,neurophysiological,and functional outcomes?Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTS After screening 148 manuscript,five papers were included in our study.43 subjects were included in the SC group,while 40 in the autograft group.The meta-analysis showed no significative differences between the two groups in terms of myelin thickness[CI:-0.10(-0.20,0.00);I^(2)=29%;P=0.06],nerve fibers diameter[CI:0.72(-0.93,3.36);I^(2)=72%;P=0.6],compound muscle action potential amplitude[CI:1.59(0.59,3.77);I^(2)=89%;P=0.15]and latency[CI:0.66(-1.01,2.32);I^(2)=67%;P=0.44].The mean axonal diameter was higher in the autograft group[CI:0.94(0.60,1.27);I^(2)=0%;P≤0.001].CONCLUSION The role of stem cells in facial reanimation is still relatively poorly studied,in animal models,and available results should not discourage their use in future studies on human subjects.
文摘Dear Editor,Evidence of oculomotor nerve(ON)synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,compressive neoplasms,cavernous sinus
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:""><span style="font-family:Verdana;">The surgery of cerebellopontine angle tumours has remarkably progressed over the last 2 decades due to improved microsurgical techniques. </span><span style="font-family:Verdana;">The primary operative goals are microscopic total removal of the tumour</span><span style="font-family:Verdana;"> while securing the adjacent cranial nerves. Facial Nerve plays a critical role in facial muscles function and one’s cosmetic appearance, and its weakness can have </span><span><span style="font-family:Verdana;">profound implications on a patient’s quality of life. </span><b><span style="font-family:Verdana;">Aim of the Study: </span></b><span style="font-family:Verdana;">To </span></span><span style="font-family:Verdana;">assess </span><span style="font-family:Verdana;">the impact of monitoring techniques on the preservation of facial nerve</span><span style="font-family:Verdana;"> function during cerebellopontine angle tumours surgery. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">This is a prospective study. This study was conducted on 30 cases (2 groups, </span><span style="font-family:Verdana;">each had 15 patients) with CPA lesions that had undergone surgical exci</span><span style="font-family:Verdana;">sion of these lesions performed by retrosigmoid approach (Group A: the</span><span style="font-family:Verdana;"> pa</span><span style="font-family:Verdana;">tients were operated under continuous intraoperative facial nerve</span><span style="font-family:Verdana;"> monitoring</span> <span style="font-family:Verdana;">(IOFNM) and Group B: the patients were operated without IOFNM). They</span> <span style="font-family:Verdana;">were operated upon in neurosurgery departments at Al-Azhar university</span><span style="font-family:Verdana;"> hosp</span><span><span style="font-family:Verdana;">itals between August 2019 and August 2021. </span><b><span style="font-family:Verdana;">Results: </span></b></span></span><span style="font-family:Verdana;">This study sho</span><span style="font-family:Verdana;">wed that </span><span style="font-family:Verdana;">excellent facial nerve function (HB Grade I and II) was higher in group A</span><span style="font-family:""><span style="font-family:Verdana;"> than group B, immediately and at 6-month post op (80% and 93% VS 53.3% and 66.7%). Intermediate (HB Grade III and VI) and Poor (HB Grade V and </span><span style="font-family:Verdana;">VI) facial nerve function was higher in group B than group A;both</span><span style="font-family:Verdana;"> immediately and 6-month postop (46.7% and 33.3% VS 20% and 6.6%). However, </span><span><span style="font-family:Verdana;">no statistically significant P-Value between both groups. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We</span></span><span style="font-family:Verdana;"> concluded that IOFNM can help, but cannot guarantee, the preservation of facial </span><span style="font-family:Verdana;">nerve. Furthermore, it is merely a technical adjunct and does not replace</span><span style="font-family:Verdana;"> surgical skills, knowledge of anatomy and experience.
文摘Objective: To identify the facial nerve trunk (FNT) very easily. quickly and accurately considering the styloid process as the robust anatomically consistent landmark during parotid surgery. Patients and Methods: This prospective study was conducted between January 2010 to December 2022 at a Tertiary care hospital. It included 130 patients: 84 (65%) males and 46 (35%) females with a mean age of 43.52 ± 15.63 years. Patients presented with pleomorphic adenoma (90), chronic sialectasis (05), parotid cyst (03), parotid sinus (01), mucoepidermoid carcinoma (28), adenoid cystic carcinoma (02) and squamous cell carcinoma (01) were subjected to superficial parotidectomy and total parotidectomy. The outcome was evaluated regarding the clinical success of facial nerve function that considered the location of the styloid process in the triangle technique for identification of the FNT during parotid surgery. Results: All 130 patients underwent superficial and total parotidectomy. The facial nerve trunk was successfully identified as the location of the styloid process in the triangle technique in all the patients with no intra-operative complications. Operative time ranged from 50 to 180 minutes with a mean time 90.70 ± 15.68 minutes. Dysfunction of the angle of the mouth due to the deficit of the marginal mandibular nerve (MMN) was noted in 5 patients (3.8%), 02 had difficulty in eye closure (1.5%). No patient reported surgical site infection, skin flap necrosis and hematoma in this series. Conclusion: Styloid process is the prominent robust landmark in the triangle technique for the identification of facial nerve trunk with relative ease, safety and accuracy in the parotid surgical procedure. This can be a very useful method to locate the FNT and minimize facial nerve injury during parotid surgery.
文摘Objective To study influence of distal portion compression of facial nerve in hemifacial spasm surgery. Methods 120 hemifacial spasm patients were undergone lateral spread response monitoring during microvascular decompression surgery. 39 patients’LSR remained after decompression of the root exit zone of the facial nerve.
文摘Objective To evaluate the long-term facial nerve funtion of patients following microsurgical removal of large and huge acoustic neuroma,and to indentify the factors that influence these outcomes. Methods A retrospective review was performed,which included 176 consecutive patients with a
基金Supported by the National Natural Science Foundation of China (No.81603706)。
文摘Objective:To explore the mechanism of electroacupuncture(EA) in promoting recovery of the facial function with the involvement of autophagy,glial cell line-derived neurotrophic factor(GDNF),and phosphatidylinositol-3-kinase(PI3K)/mammalian target of rapamycin(mTOR) signaling pathway.Methods:Seventy-two male Sprague-Dawley rats were randomly allocated into the control,sham-operated,facial nerve injury(FNI),EA,EA+3-methyladenine(3-MA),and EA+GDNF antagonist groups using a random number table,with 12 rats in each group.An FNI rat model was established with facial nerve crushing method.EA intervention was conducted at Dicang(ST 4),Jiache(ST 6),Yifeng(SJ 17),and Hegu(LI 4) acupoints for 2 weeks.The Simone’s 10-Point Scale was utilized to monitor the recovery of facial function.The histopathological evaluation of facial nerves was performed using hematoxylin-eosin(HE) staining.The levels of Beclin-1,light chain 3(LC3),and P62 were detected by immunohistochemistry(IHC),immunofluorescence,and reverse transcriptionpolymerase chain reaction,respectively.Additionally,IHC was also used to detect the levels of GDNF,Rai,PI3K,and mTOR.Results:The facial functional scores were significantly increased in the EA group than the FNI group(P<0.05 or P<0.01).HE staining showed nerve axons and myelin sheaths,which were destroyed immediately after the injury,were recovered with EA treatment.The expressions of Beclin-1 and LC3 were significantly elevated and the expression of P62 was markedly reduced in FNI rats(P<0.01);however,EA treatment reversed these abnormal changes(P<0.01).Meanwhile,EA stimulation significantly increased the levels of GDNF,Rai,PI3K,and mTOR(P<0.01).After exogenous administration with autophagy inhibitor 3-MA or GDNF antagonist,the repair effect of EA on facial function was attenuated(P<0.05 or P<0.01).Conclusions:EA could promote the recovery of facial function and repair the facial nerve damages in a rat model of FNI.EA may exert this neuroreparative effect through mediating the release of GDNF,activating the PI3K/mTOR signaling pathway,and further regulating the autophagy of facial nerves.
文摘Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.
文摘Accurate localization of cranial nerves and responsible blood vessels is important for diagnosing trigeminal neuralgia(TN)and hemifacial spasm(HFS).Manual delineation of the nerves and vessels on medical images is time-consuming and labor-intensive.Due to the development of convolutional neural networks(CNNs),the performance of medical image segmentation has been improved.In this work,we investigate the plans for automated segmentation of cranial nerves and responsible vessels for TN and HFS,which has not been comprehensively studied before.Different inputs are given to the CNN to find the best training configuration of segmenting trigeminal nerves,facial nerves,responsible vessels and brainstem,including the image modality and the number of segmentation targets.According to multiple experiments with seven training plans,we suggest training with the combination of three-dimensional fast imaging employing steady-state acquisition(3D-FIESTA)and three-dimensional time-of-flight magnetic resonance angiography(3DTOF-MRA),and separate segmentation of cranial nerves and vessels.
基金supported by the United States National Institute of Health grant 1K08DC012535(to MJB)Program for Neurology Research and Discoverythe Sinai Medical Staff Foundation Neuroscience Scholar Fund(to ELF)
文摘The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.
基金This study was financially supported by the National Key R&D Program of China,Nos.2018YFC2001600(to JGX),2018YFC2001604(to CLS)Shanghai Jiao Tong University Multidisciplinary Research Fund of Medicine and Engineering,China,No.YG 2016QN13(to WD)+2 种基金Intelligent Medical Program of Shanghai Health Commission,China,No.2018ZHYL0216(to CLS)Clinical Science and Technology Innovation Project of Shanghai Shen Kang Hospital Development Center,China,No.SHDC12018126(to JGX and CLS)Shanghai Health Commission Accelerated the Development of Traditional Chinese Medicine Three-Year Action Plan Project,China,No.ZY(2018-2020)-CCCX-2001-06(to CLS).
文摘Facial synkinesis is a troublesome sequelae of facial nerve malfunction.It is difficult to recover from synkinesis,despite improved surgical techniques for isolating the peripheral facial nerve branches.Furthermore,it remains unclear whether long-term dysfunction of motor control can lead to irreversible plasticity-induced structural brain changes.This case-control study thus investigated the structural brain alterations associated with facial synkinesis.The study was conducted at Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China.Twenty patients with facial synkinesis(2 male and 18 female,aged 33.35±6.97 years)and 19 healthy volunteers(2 male and 17 female,aged 33.21±6.75 years)underwent magnetic resonance imaging,and voxel-based and surface-based morphometry techniques were used to analyze data.There was no significant difference in brain volume between patients with facial synkinesis and healthy volunteers.Patients with facial synkinesis exhibited a significantly reduced cortical thickness in the contralateral superior and inferior temporal gyri and a reduced sulcal depth of the ipsilateral precuneus compared with healthy volunteers.In addition,sulcal depth of the ipsilateral precuneus was negatively correlated with the severity of depression.These findings suggest that there is a structural remodeling of gray matter in patients with facial synkinesis after facial nerve malfunction.This study was approved by the Ethics Review Committee of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China(approval No.2017-365-T267)on September 13,2017,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR1800014630)on January 25,2018.
基金Supported by 2015 Yeungnam University Research,Korea,No. 215A380222
文摘BACKGROUND Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed,raising public concerns regarding the side effects of immunization,as the incidence of ease.Although many adverse events following the coronavirus disease 2019(COVID-19)vaccine have been reported,neurological complications are relatively uncommon.Herein,we report a rare case of multiple cranial palsies following COVID-19 vaccination in an adolescent patient.CASE SUMMARY A previously healthy,14-year-old Asian girl with facial palsy presented to the emergency department with inability to close the right eye or wrinkle right side of the forehead,and pain in the right cheek.She had received second dose of the COVID-19 mRNA vaccine(Pfizer-BioNTech)18 days before onset of symptoms.She was diagnosed with Bell’s palsy and prescribed a steroid(1 mg/kg/day methylprednisolone)based on symptoms and magnetic resonance imaging findings.However,the next day,all sense of taste was lost with inability to swallow solid food;the gag reflex was absent.Horizontal diplopia was also present.Due to worsening of her condition,she was given high-dose steroids(1g/day methylprednisolone)for 3 days and then discharged with oral steroids.Improvement in the symptoms was noted 4 days post steroid treatment completion.At the most recent follow-up,her general condition was good with no symptoms except diplopia;ocular motility disturbances were noted.Hence,prism glasses were prescribed for diplopia relief.CONCLUSION Small-angle exotropia was observed in the facial,trigeminal,and glossopharyngeal nerve palsies,in our patient.The etiology of this adverse effect following vaccination was thought to be immunological.
