Factors influencing the preservation of the facial nerve during acoustic surgery

Abstract

We reviewed the last 30 acoustic neuromas excised in our department and attempted to find out the factors associated with preservation of the facial and cochlear nerves. While the size of the tumour was the most important factor, vascularity and consistency were both important. Facial and cochlear nerves were preserved in 63% and 10% of the patients respectively. The importance of early diagnosis cannot be overemphasized.

Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery

“…On the other hand, the conclusions from the study may be related to the retrosigmoid approach only. Most of the authors agree that the size of the tumour, its consistency and degree of adherence between the lesion and the nerve have a major influence on facial nerve outcome [2,23,27,29,31,34]. Crucial among them is the size of the tumour [9,20,21,37].…”

Anterior Extension of Tumor is as Important as Tumor Size to Facial Nerve Outcome and Extent of Resection for Vestibular Schwannomas

“…Our results confirm the significant impact of tumor size on surgical outcome. 2,6,[14][15][16][17][18][19][20][21][22] The AC measurement, which is conventionally how studies have reported tumor size, was a statistically significant predictor of postoperative facial nerve outcome on univariate analysis. However, on multivariate analysis, only the AB measurement (anterior tumor extension) and the EB/BF ratio (growth parallel to the IAC) remained significantly associated with facial function, suggesting that tumor dimension is as important as tumor size to facial nerve outcome.…”

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

“…1,3,5,6,21,23,27 In surgery for acoustic neuromas, EMG neuromonitoring has become a routine tool used to identify and protect the seventh cranial nerve; however, additional postoperative facial paresis has been reported in 10 to 27% of cases, especially following excision of large tumors. 7,18,19,28,29,31 The rate of anatomical and functional preservation of the facial nerve was significantly lower in the era before standard EMG monitoring was applied routinely. 10,29 Electrical stimulation of the facial nerve during removal of large acoustic neuromas has been widely used for longer than 20 years.…”