Facial nerve outcomes in functional vestibular schwannoma surgery: less than total tumour excision significantly improves results

• Published in: Journal of laryngology and otology 2012-02, Vol.126 (2), p.120-124
• Main Authors: Martin, T P C, Fox, H, Ho, E-C, Holder, R, Walsh, R, Irving, R M
• Format: Article
• Language: English
• Subjects: Audit departments; Biological and medical sciences; Case-Control Studies; Cranial Nerve Neoplasms - physiopathology; Cranial Nerve Neoplasms - surgery; Data collection; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Facial nerve; Facial Nerve - physiopathology; Facial Paralysis - etiology; Facial Paralysis - prevention & control; Female; Humans; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - epidemiology; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neuroma, Acoustic - physiopathology; Neuroma, Acoustic - surgery; Non tumoral diseases; Otologic Surgical Procedures - methods; Otologic Surgical Procedures - rehabilitation; Otorhinolaryngology. Stomatology; Outcome Assessment (Health Care) - statistics & numerical data; Patient Satisfaction; Patients; Philosophy; Postoperative Period; Preservation; Schwann cells; Surgeons; Surgery; Tumors; Vestibular system
• ISSN: 0022-2151; 1748-5460
• DOI: 10.1017/S0022215111003124

To determine the implications of a functional approach to vestibular schwannoma surgery, with facial nerve function prioritised higher than total tumour excision. A case-control study in a tertiary referral neurotology clinic. A 'functional' surgical group treated after April 2007 (n = 44, mean cerebellopontine angle dimension 27 mm), and an 'excisional' surgical group matched for tumour size, treated from 1997 to April 2007 (n = 115). Change to more functional surgical approach. facial nerve status. Secondary outcome: tumour recurrence in less-than-total tumour excision. Facial nerve preservation: 77 per cent House-Brackmann grade I-II in functional group at 12 months, versus 57 per cent grade I-II in excisional group (p = 0.027). Tumour recurrence: 1 per cent in total excision group, 2 per cent in near-total group and 40 per cent in sub-total group. A functional approach to vestibular schwannoma surgery improves facial nerve preservation outcomes and reduces the requirement for facial nerve rehabilitative interventions. Tumour recurrence rates are low in near-totally excised lesions but significant if only sub-total excision is achieved.