Application of multi-mode intraoperative monitoring of facial nerve structure and function preservation during giant vestibular schwannomas surgery: A retrospective study

Abstract

Objectives To explore the application value of intraoperative multi-mode facial nerve monitoring during resection of giant vestibular schwannomas and to provide evidence for further technical and surgical refinements. Methods A total of 58 patients with giant vestibular schwannomas (tumor diameter≥3 cm) underwent microsurgical resection at Department of Neurosurgery, the First Affiliated Hospital of Xiamen University and were retrospectively analyzed in this study. From December 2016 to January 2018, 28 cases who received multi-mode intraoperative monitoring were set as monitoring group. From March 2013 to November 2016, 30 cases without multi-mode intraoperative monitoring were set as control group. The baseline data (age, sex, size of tumor, cystic-solid quality of tumor, side of tumor), operational duration, surgical resection rate, anatomical and function preservation (evaluated based on House-Brackmann grade) of facial nerves and postoperative complication were compared between the 2 groups. Results The operational duration was obviously shorter in monitoring group (413.4±166.1 min) with statistical difference (t=-2.02, P=0.048) compared to that in control group (499.7±159.6 min). Total resection rate in monitoring group was 100.0% (28/28) and that in control group was 93.3% (28/30). Anatomical preservation rate in monitoring group was 100.0% (28/28) while that in control group was 90.0% (27/30). There was no significant difference in total resection rate or anatomical preservation rate between the 2 groups(both P>0.05). Significantly higher function preservation rate of facial nerves was observed in monitoring group than in control group at 1 week (P=0.043) and 3 months (P=0.039) post surgery. The incidence rate of complication was lower (P=0.029) in monitoring group (14.3%) than in control group(40.0%). Conclusion Intraoperative multi-mode facial nerve monitoring could help shorten the operation duration, increase the function preservation rate of the facial nerves and reduce the clinical postoperative complications. Key words: Neuroma, acoustic; Neurosurgical procedures; Facial nerve; Intraoperative neurophysiologic monitoring