Facial Nerve Results in Large Vestibular Schwannoma Surgery

✍ Scribed by Calhoun D. Cunningham III; John T. McElveen Jr.; Takanori Fukushima

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 133 KB
• Volume: 119
• Category: Article
• ISSN: 0023-852X
• DOI: 10.1002/lary.20402

✦ Synopsis

Objectives: 1) To determine facial nerve outcomes following the surgical removal of large vestibular schwannomas; and, 2) to understand the indications and implications of surgical treatment of large vestibular schwannomas.

Study Design: Retrospective case review.

Methods: Retrospective case review of fifty patients undergoing surgical removal of large vestibular schwannomas measuring 3.0 cm or greater in size between October 1995 and July 2006 at a tertiary referral neurotologic center. Size, completeness of tumor removal, and 1 year postoperative facial nerve outcomes were assessed using the House-Brackmann facial nerve grading scale.

Results:

The mean tumor size was 3.5 cm. Gross total tumor removal was achieved in 76% of patients with near-total or subtotal resections elected intraoperatively in 12 patients. The facial nerve was preserved anatomically in 49 patients. One year postoperative facial nerve results demonstrated House-Brackmann grade I or II function in 92% of patients.

Conclusions:

Microsurgical resection remains the treatment of choice for large vestibular schwannomas. Excellent facial nerve outcomes can be obtained in the majority of patients with minimal morbidity. Emphasis should be placed on preservation of facial nerve function, and in select cases, alternative treatment strategies may be employed to improve facial nerve outcomes.