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

Published online by Cambridge University Press:  13 December 2011

T P C Martin ,
H Fox ,
E-C Ho ,
R Holder ,
R Walsh  and
R M Irving
T P C Martin*
Affiliation:
Department of ENT, Queen Elizabeth Hospital, Birmingham, UK
H Fox
Affiliation:
Department of ENT, Queen Elizabeth Hospital, Birmingham, UK
E-C Ho
Affiliation:
Department of ENT, Queen Elizabeth Hospital, Birmingham, UK
R Holder
Affiliation:
Department of Medical Statistics, Birmingham University, UK
R Walsh
Affiliation:
Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
R M Irving
Affiliation:
Department of ENT, Queen Elizabeth Hospital, Birmingham, UK
*
Address for correspondence: Mr T P C Martin, 1 Charles St, Cambridge CB1 3LZ, UK E-mail: [email protected]
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Abstract

Objectives:

To determine the implications of a functional approach to vestibular schwannoma surgery, with facial nerve function prioritised higher than total tumour excision.

Study design:

A case–control study in a tertiary referral neurotology clinic.

Patients:

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).

Intervention:

Change to more functional surgical approach.

Main outcomes measured:

Primary outcome: facial nerve status. Secondary outcome: tumour recurrence in less-than-total tumour excision.

Results:

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.

Conclusion:

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.

Keywords

Acoustic NeuromaSurgeryPathologyFacial Nerve Paralysis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 2 , February 2012 , pp. 120 - 124
Copyright
Copyright © JLO (1984) Limited 2011

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