The role of intraoperative neuromonitoring of facial nerve in microsurgical excision of vestibular schwannomas

Abstract

Abstract Background Preserving the function of facial nerve (FN) is an important objective of cerebellopontine angle tumor excision. FN paresis and paralysis possibly happen postoperatively, in particular for vestibular schwannoma (VS) excision, despite efforts to prevent injury and preserve anatomic integrity of the FN during dissection. Aim Evaluation of the role of neuromonitoring of FN in microsurgical resection of VSs and its impact on FN function preservation and quality of life. Patients and methods This trial was conducted on 22 patients with VS in the period from February 2018 to February 2020. All patients had undergone VS microsurgical excision in the Neurosurgery Department, Tanta University Hospitals. Results According to House-Brackmann grading scale, the functions of FN postoperatively were grade I in 16 patients (72.6%), grade III in three patients (13.6%), grade IV in two patients (9%), and grade V in one patient (4.7%). So, House-Brackmann grading scale II to VI means preservation less than 100%, which was achieved in six patients (27.3%). Conclusion Intraoperative neurophysiologic monitoring plays an essential step in modern skull base surgery generally and in VS surgery specifically. FN electromyography does not only help localize and identify the anatomy of FN but as well keep FN integrity of function and can be helpful in the prediction of its postoperative functional outcome.