Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Abstract

Object. The goal of this article was to show that a combination of facial nerve-sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS).Methods. Records of individuals treated by a single surgeon with a facial nerve-sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.2%) of these patients required postoperative retreatment for a significant expansion of residual tumor after microsurgery. These 20 patients were re-treated with GKS.Results. The rate of preservation of good facial nerve function (Grade I or II on the House-Brackmann scale) in patients treated with microsurgery for VS was 97%. Both subtotal and gross-total resection had excellent facial nerve preservation rates (97% vs 96%), although subtotal resection carried a higher risk that patients would require retreatment. In patients re-treated with GKS after microsurgery, the rate of facial nerve preservation was 95%.Conclusions. In patients with tumors that cannot be managed with radiosurgery alone, a facial nerve-sparing resection followed by GKS for any significant regrowth provides excellent facial nerve preservation rates. (DOI: 10.3171/2011.7.JNS101921) key WoRDs • vestibular schwannoma • facial nerve • Gamma Knife surgery • tumor recurrence • peripheral nerve 917Abbreviations used in this paper: GKS = Gamma Knife surgery; GTR = gross-total resection; HB = House-Brackmann; IAC = internal auditory canal; NF2 = neurofibromatosis Type 2; STR = subtotal resection; VS = vestibular schwannoma.

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

“…We have previously published on the safety and efficacy of this paradigm for the resection of vestibular schwannomas where facial nerve motor function (defined as House-Brackmann Grade I or II) was preserved in 97% of patients. 9 However, the safety and efficacy of this approach in CPA meningiomas has not been well examined. In the present series, we review our experience and outcomes with treating meningiomas of the CPA in one of the largest series by a single surgeon to date.…”

“…Patients with tumors 2.5 cm or larger in the largest diameter were treated with microsurgical resection. 9 Exceptions were made at the discretion of the surgeon in the setting of significant comorbidities, advanced age, debilitating symptoms of vertigo or tinnitus, or significant mass effect on surrounding structures. These patients were analyzed within the group in which they were ultimately treated.…”

“…Significant growth was defined as tumor expansion of at least 5.0 mm in any direction on contrast-enhanced MRI compared with postoperative imaging, as previously described. 9 Facial nerve function before and after intervention was documented according to the House-Brackmann facial nerve grading system. Good facial function was defined as House-Brackmann Grade I or II.…”

“…We have previously demonstrated the effectiveness of this approach for the treatment of vestibular schwannoma with preservation of good facial nerve function in 97% of treated patients. 9 Here, we pay specific attention to rates of facial nerve preservation and investigate the clinical and prognostic significance of the tumor origin along the petrous bone with respect to the internal auditory canal (IAC).…”

The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation

“…However, surgeons still pursue the ideal management of VS due to the importance of facial nerve function in the patients' quality of life 15 . The knowledge of microsurgical anatomy played an important role decreasing morbidity and mortality rates.…”