Facial nerve injury in acoustic neuroma (vestibular schwannoma) surgery: etiology and prevention. J Neurosurg

Department of Neurological Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287-7709, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 08/1997; 87(1):60-6. DOI: 10.3171/jns.1997.87.1.0060
Source: PubMed


Facial nerve injury associated with acoustic neuroma surgery has declined in incidence but remains a clinical concern. A retrospective analysis of 611 patients surgically treated for acoustic neuroma between 1973 and 1994 was undertaken to understand patterns of facial nerve injury more clearly and to identify factors that influence facial nerve outcome. Anatomical preservation of the facial nerve was achieved in 596 patients (97.5%). In the immediate postoperative period, 62.1% of patients displayed normal or near-normal facial nerve function (House-Brackmann Grade 1 or 2). This number rose to 85.3% of patients at 6 months after surgery and by 1 year, 89.7% of patients who had undergone acoustic neuroma surgery demonstrated normal or near-normal facial nerve function. The surgical approach appeared to have no effect on the incidence of facial nerve injury. Poor facial nerve outcome (House-Brackmann Grade 5 or 6) was seen in 1.58% of patients treated via the suboccipital approach and in 2.6% of patients treated via the translabyrinthine approach. When facial nerve outcome was examined with respect to tumor size, there clearly was an increased incidence of facial nerve palsy seen in the immediate postoperative period in cases of larger tumors: 60.8% of patients with tumors smaller than 2.5 cm had normal facial nerve function, whereas only 37.5% of patients with tumors larger than 4 cm had normal function. This difference was less pronounced, however, 6 months after surgery, when 92.1% of patients with tumors smaller than 2.5 cm had normal or near normal facial function, versus 75% of patients with tumors larger than 4 cm. The etiology of facial nerve injury is discussed with emphasis on the pathophysiology of facial nerve palsy. In addition, on the basis of the authors' experience with these complex tumors, techniques of preventing facial nerve injury are discussed.

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    • "The risk of facial nerve palsy after microsurgical removal of VS cannot be entirely eliminated, even with refinements in surgical technique. Thus, surgical resection of these tumors is associated with significant risk of physical, cosmetic, and psychological morbidity associated with significant facial nerve palsy [8, 23]. Previously, in a systematic review of the literature, we focused on factors associated with reported rates of facial nerve function in a large population of 11,873 patients treated VS, and found that patients with larger tumors were less likely to have preserved facial nerve function after surgery than patients with smaller tumors (≤2.0 cm 90% vs. >2.0 "
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    ABSTRACT: Avoidance of facial nerve palsy is one of the major goals of vestibular schwannoma (VS) microsurgery. In this study, we examined the significance of previously implicated prognostic factors (age, tumor size, the extent of resection and the surgical approach) on post-operative facial nerve function. We selected all VS patients from prospectively collected database (1984-2009) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. The effect of variables such as surgical approach, tumor size, patient age and extent of resection on rates facial nerve dysfunction after surgery, were analyzed using multivariate logistic regression. Patients with preoperative facial nerve dysfunction (House-Brackman [HB] score 3 or higher) were excluded, and HB grade of 1 or 2 at the last follow-up visit was defined as "facial nerve preservation." A total of 624 VS patients were included in this study. Multivariate logistic regression analysis found that only pre-operative tumor size significantly predicted poorer facial nerve outcome for patients followed-up for ≥6 and ≥12 months (OR 1.27, 95% CI 1.09-1.49, p < 0.01; OR 1.35, 95% CI 1.10-1.67, P < 0.01, respectively). We found no significant relationship between facial nerve function and age, extent of resection, surgical approach, or tumor size (when extent of resection and surgical approach were included in the regression analysis). Because facial nerve palsy is a debilitating and psychologically devastating condition for the patient, we suggest altering surgical aggressiveness in patients with unfavorable tumor anatomy, particularly in cases with large tumors where overaggressive resection might subject the patient to unwarranted risk. Residual disease can be followed and controlled with radiosurgery if interval growth is noted.
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    Full-text · Article · Jul 1992 · Journal of Neurosurgery
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    ABSTRACT: 1. Tinnitus is a common symptom in individuals with vestibular schwannoma (VS). 2. In 70–80% of cases, VS is ipsilateral to the tumor. It is the principal symptom in 10% and is moderate to severe in 14% of individuals. 3. Tinnitus in VS is typically associated with hearing loss (95%) and disorders of balance (50%). 4. Tinnitus in VS is mostly of high pitch. 5. Tinnitus is the predominant symptom in very small and very large tumors. 6. On the average tinnitus is not altered by gamma knife treatment, translabyrinth surgery, or retrosigmoid microneurosurgery, but the tinnitus of individual patients may improve or worsen after such treatments. 7. After retrosigmoid microneurosurgery tinnitus is often less troublesome than before the surgery. 8. Tinnitus might worsen after retrosigmoid tumor removal in operations in which attempts are made to spare hearing.
    Preview · Article · Jan 1994 · Journal of the Royal Society of Medicine
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