Abstract
In this study we evaluate the postoperative facial nerve function after vestibular
schwannoma (VS) surgery and analyze the factors that cause it. We included 97 consecutive
patients undergoing surgical excision of sporadic unilateral VS. Patient and tumor
characteristics, surgical approaches, facial nerve function, extent of tumor removal,
perioperative complications are all analyzed through standardized systems. Four different
surgical approaches are used: translabyrinthine, retrolabyrinthine, retrosigmoid,
and middle cranial fossa. Anatomic preservation of the facial nerve is achieved in
97% of patients. The incidence of postoperative facial palsy is found to be statistically
correlated to tumor size, but not to the surgical approach used and to extent of tumor
penetration in the internal auditory canal. A significant improvement of the short-term
facial nerve outcome is detected in patients undergone simultaneous intraoperative
electromyography (EMG) and pneumatic facial nerve monitoring. Complete tumor excision
is achieved in 94% of cases. Complication rates are excellent and no deaths are reported.
Short- and long-term facial nerve outcome is good and comparable with those of other
series reported in literature. In VS surgery both EMG and pneumatic facial nerve monitors
should be simultaneously used. Further investigations are desirable to improve the
facial outcome respecting the oncological radicality.
Keywords
vestibular schwannoma surgery - acoustic neuroma surgery - facial nerve monitoring
- facial nerve palsy
