Abstract
Objective To obtain structural and functional visualization of facial nerve (FN)by preoperative identification with diffusion tensor tracking (DTT) and intraoperative electrophysical monitoring (IOM) and explore the effect of these techniques on preservation of facial nerve in large vestibular schwannoma (extrameatal diameter≥ 30 mm,VS) surgery.Methods Fifteen patients habouring large VS were adopted in this retrospective study.Structural and functional visualization of FN was conducted in each patient.Correlation of FN location between preoperative identification and intraoperative inspection was analysed.Postoperative FN function was evaluated in each patient periodically.Results FN was identified by DTT in 13 cases.Seven FNs located at the anterior middle third of the tumor,3 at the anterior inferior third,2 at the anterior superior third,and 1 at the inferior pole.The locations agreed to intraoperative findings and monitoring in all the 13 cases.Gross total resection was achived in 11 cases and subtotal in the other 4 cases.IOM was helpful to locate and protect the FN.All FNs were anatomically preserved.House-Brackmann grade Ⅰ of FN function was achieved in 8 cases,grade Ⅱ in 6,and grade Ⅳ in one.Conclusion Structural visualization by preoperative DTT and functional visualization by IOM of FN contribute to lacating and preserving FN in large VS surgery. Key words: Vestibular schwannoma; Facial nerve; Diffusion tensor tracking; Intraoperative electrophysical monitoring; Microsurgery
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