Facial Nerve Results in Large Vestibular Schwannoma Surgery

Abstract

Surgical removal remains the primary mode of therapy for large vestibular schwannomas. The current goals of treatment are preservation of life, avoidance of brain injury and reduction of cranial nerve deficits. Although historically, poorer facial nerve outcomes are associated with removal of large vestibular schwannomas, we have demonstrated excellent facial nerve results in 94% of patients. It should be noted that in large tumors, facial nerve function is often correlated with the extent of tumor removal. In our current series, 76% of patients underwent total tumor removal and in 24%, subtotal removal was elected intraoperatively. Of the 9 patients who underwent subtotal removal, 1 patient has required revision surgery and the remaining 8 continue to be followed with serial imaging and have stable residual tumors. Total tumor removal is an important goal in order to reduce the risk of future surgery, however, consideration should be given to the risk of permanent facial nerve weakness. Facial nerve dysfunction greatly impacts quality of life and additional rehabilitation can be costly. In order to further reduce the risk of facial nerve dysfunction, alternative surg ical treatment strategies have been described when addressing the treatment of large tumors. Recent studies by Patni and Kartush (2005) demonstrated H-B grade I facial nerve function in 94% of patients following staged resection of large tumors 7 . Furthermore, treatment options