Vestibular schwannoma microsurgery with special reference to facial nerve preservation

• Published in: Clinical neurology and neurosurgery Vol. 111; no. 1; pp. 47 - 53
• Main Authors: Chen, Lihua, Chen, Ling, Liu, LiXu, Ling, Feng, Yuan, Xianrui, Fang, Jiasheng, Liu, Yunsheng
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.01.2009; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Audiometry, Pure-Tone - methods; Biological and medical sciences; Evoked Potentials, Auditory, Brain Stem - physiology; Facial Nerve - physiopathology; Facial Nerve - surgery; Facial nerve function; Female; Hearing loss; Humans; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical sciences; Microsurgery; Microsurgery - adverse effects; Microsurgery - methods; Middle Aged; Monitoring, Intraoperative - methods; Mortality; Nerve monitoring; Neurology; Neuroma, Acoustic - pathology; Neuroma, Acoustic - physiopathology; Neuroma, Acoustic - surgery; Neurosurgery; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Preservation; Recovery of Function; Retrosigmoid transmeatal approach; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical outcomes; Surgical techniques; Tomography, X-Ray Computed - methods; Tumors; Veins & arteries; Vertigo; Vestibular schwannoma; Young Adult; Nerve monitoring; Facial nerve function; Vestibular schwannoma; Retrosigmoid transmeatal approach; Nervous system diseases; Preservation; Neurinoma; Facial nerve; Surgery; Microsurgery; Surgical approach; Benign neoplasm; Monitoring
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2008.07.012

Abstract Objective To retrospectively study the outcomes of vestibular schwannoma (VS) resection. Methods Between January 2003 and December 2006, 103 consecutive patients who had undergone VS resection were included in this study. Medical records, operation summaries, follow-up data, and neuroradiological findings were analyzed. The relationship between tumor size, location, and topography relative to the facial nerve bundles was studied for a mean duration of 16 months (range: 3–39 months). Results Complete tumor resection in combination with anatomic preservation of the facial nerve was achieved in 101 (98.1%) cases. The facial nerve was fully preserved in 100% of cases with small or medium tumors and in 37/39 patients with large tumors. Overall, 83.5% of patients had normal or near-normal facial nerve function 3–12 months post-surgically. The mortality rate was 0%. Conclusions Even in large VS, preservation of facial nerve function (H-B Grade I or II) should be prioritized over total resection. For tumors >3 cm, the goal of low morbidity and maintenance of normal facial nerve function can be attained with the retrosigmoid transmeatal approach, refined microsurgical technique, and intraoperative facial nerve monitoring.