Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T12:09:36.589Z Has data issue: false hasContentIssue false
  • English
  • Français

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]
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Marouf, R, Noudel, R, Roche, PH. Facial nerve outcomes after microsurgical resection of vestibular schwannoma. In: Regis, J, Roche, P-H, eds. Modern Management of Acoustic Neuroma. Basel: Karger, 2008;103–7CrossRefGoogle Scholar
2Ryzenman, JM, Pensak, ML, Tew, JM. Facial paralysis and surgical rehabilitation: a quality of life analysis in a cohort of 1,595 patients after acoustic neuroma surgery. Otol Neurotol 2005;26:516–21CrossRefGoogle Scholar
3House, JW, Brackmann, DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146–7CrossRefGoogle ScholarPubMed
4Silverstein, H, McDaniel, A, Norrell, H, Wazen, J. Conservative management of acoustic neuroma in the elderly patient. Laryngoscope 1985;95:766–70CrossRefGoogle ScholarPubMed
5Freeman, SR, Ramsden, RT, Saeed, SR, Alzoubi, FQ, Simo, R, Rutherford, SA et al. Revision surgery for residual or recurrent vestibular schwannoma. Otol Neurotol 2007;28:1076–82CrossRefGoogle ScholarPubMed
6Kanzaki, J, Tos, M, Sanna, M, Moffat, D. New and modified reporting systems from the Consensus Meeting on Systems for Reporting Results in Vestibular Schwannoma. Otol Neurotol 2003;24:642–8CrossRefGoogle ScholarPubMed
7Bloch, DC, Oghalai, JS, Jackler, RK, Osofsky, M, Pitts, L. The fate of the tumor remnant after less-than-complete acoustic neuroma resection. Otolaryngol Head Neck Surg 2004;130:104–12CrossRefGoogle ScholarPubMed
8Seol, HJ, Kim, CH, Park, CK, Kim, CH, Kim, DG, Chung, YS et al. Optimal extent of resection in vestibular schwannoma surgery: relationship to recurrence and facial nerve preservation. Neurol Med Chir (Tokyo) 2006;46:176–80CrossRefGoogle ScholarPubMed
9Sakaki, S, Nakagawa, K, Hatakeyama, T, Murakami, Y, Ohue, S, Matsuoka, K. Recurrence after incompletely resected acousticus neurinomas. Med J Osaka Univ 1991:40;59–66Google ScholarPubMed
10El-Kashlan, HK, Zeitoun, H, Arts, HA, Hoff, JT, Telian, SA. Recurrence of acoustic neuroma after incomplete resection. Am J Otol 2000;21:389–92CrossRefGoogle ScholarPubMed
11Godefroy, WP, van de May, AG, de Bruine, FT, Hoekstra, ER, Malessy, MJ. Surgery for large vestibular schwannoma: residual tumour and outcome. Otol Neurotol 2009;30:629–34CrossRefGoogle ScholarPubMed