Neurosurgical forum
Letters
to
the
editor
Facial Anastomosis
To THE EDITOR: I wonder if I might ask Dr. DiTullio and his fellow authors to clarify one point made in their interesting article comparing neurosurgical and otolaryngological approaches to acoustic neuromas (DiTullio MV, Malkasian D, Rand RW: A critical comparison of neurosurgical and otolaryngological approaches to acoustic neuromas. J Neurosurg 48:1-12, January, 1978)? Their results are exceptionally good and speak for themselves but, in discussing the preservation of the facial nerve, they mentioned that following surgery "facial motor activity, while normal in 42% of their cases, was partially deficient in an equal number of patients." They go on to say that "Each of these groups included three individuals who had undergone direct facial reanastomosis o r delayed facial-hypoglossal anastomosis to compensate for unavoidable intraoperative sacrifice of a tumor-involved nerve." Do the authors mean that they obtained normal facial motor activity after facial nerve reanastomosis? These patients presumably had a complete facial palsy immediately postoperatively. My own experience with about 160 acoustic nerve tumors has been that even where the nerve is in continuity the result is likely to be very imperfect facial nerve function if the patient develops a facial nerve palsy immediately after the operation. I am surprised to hear that complete division of the nerve may be followed by normal facial nerve function. | was also not quite clear whether the quotation above meant that one could obtain normal facial nerve function from a facial hypoglossal anastomosis. T. T. KING,F.R.C.S. London, England 328
RESPONSE: We would like to congratulate Dr. King for his careful attention to our article. He is indeed correct. Our statement was misworded and should have read: "Within the latter category were included two groups, of three individuals each, who had undergone direct facial reanastomosis or delayed facial hypoglossal anastomosis to compensate for unavoidable intraoperative sacrifice of a tumor-involved nerve." Following such reconstruction, each of these patients demonstrated moderate to excellent muscular tone, and all were capable of simultaneously performed mass movements such as eye closure, cheek elevation, and an attempt at a symmetrical smile. Unfortunately, normal physiological function, as judged by the independent movement of individual muscle groups, was observed in none of those patients who had experienced complete sectioning of the facial nerve. We appreciate this opportunity to clarify this particular point. MICHAELV. DffULUO,JR., M.D. South Weymouth, Massachusetts Dexamethasone and 5-HT Studies: Erratum
To THE EDITOR: In our recent article (Mendelow AD, Eidelman BH, McCalden TA: The effect of intracarotid infusion of dexamethasone and 5-hydroxytryptamine on cerebral blood flow and metabolism in baboons. J Neurosurg 48:594-600, April, 1978) the dosage of 5-hydroxytryptamine was incorrectly stated on page 596 as (1.0, 2.5, and 10.0 gm/kg/min). This should have read: (1.0, 2.5, and 10.0 ug/kg/min). Elsewhere in the articlb the dosage units were correct. A. DAVIDMENDELOW,F.R.C.S. Edinburgh, Scotland J. Neurosurg. / Volume 49 / August, 1978
Letters
to
the
editor
Facial Anastomosis
To THE EDITOR: I wonder if I might ask Dr. DiTullio and his fellow authors to clarify one point made in their interesting article comparing neurosurgical and otolaryngological approaches to acoustic neuromas (DiTullio MV, Malkasian D, Rand RW: A critical comparison of neurosurgical and otolaryngological approaches to acoustic neuromas. J Neurosurg 48:1-12, January, 1978)? Their results are exceptionally good and speak for themselves but, in discussing the preservation of the facial nerve, they mentioned that following surgery "facial motor activity, while normal in 42% of their cases, was partially deficient in an equal number of patients." They go on to say that "Each of these groups included three individuals who had undergone direct facial reanastomosis o r delayed facial-hypoglossal anastomosis to compensate for unavoidable intraoperative sacrifice of a tumor-involved nerve." Do the authors mean that they obtained normal facial motor activity after facial nerve reanastomosis? These patients presumably had a complete facial palsy immediately postoperatively. My own experience with about 160 acoustic nerve tumors has been that even where the nerve is in continuity the result is likely to be very imperfect facial nerve function if the patient develops a facial nerve palsy immediately after the operation. I am surprised to hear that complete division of the nerve may be followed by normal facial nerve function. | was also not quite clear whether the quotation above meant that one could obtain normal facial nerve function from a facial hypoglossal anastomosis. T. T. KING,F.R.C.S. London, England 328
RESPONSE: We would like to congratulate Dr. King for his careful attention to our article. He is indeed correct. Our statement was misworded and should have read: "Within the latter category were included two groups, of three individuals each, who had undergone direct facial reanastomosis or delayed facial hypoglossal anastomosis to compensate for unavoidable intraoperative sacrifice of a tumor-involved nerve." Following such reconstruction, each of these patients demonstrated moderate to excellent muscular tone, and all were capable of simultaneously performed mass movements such as eye closure, cheek elevation, and an attempt at a symmetrical smile. Unfortunately, normal physiological function, as judged by the independent movement of individual muscle groups, was observed in none of those patients who had experienced complete sectioning of the facial nerve. We appreciate this opportunity to clarify this particular point. MICHAELV. DffULUO,JR., M.D. South Weymouth, Massachusetts Dexamethasone and 5-HT Studies: Erratum
To THE EDITOR: In our recent article (Mendelow AD, Eidelman BH, McCalden TA: The effect of intracarotid infusion of dexamethasone and 5-hydroxytryptamine on cerebral blood flow and metabolism in baboons. J Neurosurg 48:594-600, April, 1978) the dosage of 5-hydroxytryptamine was incorrectly stated on page 596 as (1.0, 2.5, and 10.0 gm/kg/min). This should have read: (1.0, 2.5, and 10.0 ug/kg/min). Elsewhere in the articlb the dosage units were correct. A. DAVIDMENDELOW,F.R.C.S. Edinburgh, Scotland J. Neurosurg. / Volume 49 / August, 1978
