Vestibular schwannoma microsurgery with special reference to facial nerve preservation

Chen, Lihua; Chen, Ling; Liu, LiXu; Ling, Feng; Yuan, Xianrui; Fang, Jiasheng; Liu, Yunsheng

doi:10.1016/j.clineuro.2008.07.012

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Volume 111, Issue 1 , Pages 47-53, January 2009

Vestibular schwannoma microsurgery with special reference to facial nerve preservation

Chen Lihua
- Department of Neurosurgery, Xuanwu Hospital, The Capital Medical University, China International Neuroscience Institute, Changchu Street 45, Beijing 100053, China
Chen Ling
- Department of Neurosurgery, Xuanwu Hospital, The Capital Medical University, China International Neuroscience Institute, Changchu Street 45, Beijing 100053, China
- Corresponding author. Tel.: +86 10 83198852.
Liu LiXu
- Department of Neurosurgery, Xuanwu Hospital, The Capital Medical University, China International Neuroscience Institute, Changchu Street 45, Beijing 100053, China
Ling Feng
- Department of Neurosurgery, Xuanwu Hospital, The Capital Medical University, China International Neuroscience Institute, Changchu Street 45, Beijing 100053, China
Yuan Xianrui
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
Fang Jiasheng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China
Liu Yunsheng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China

Received 29 December 2007; received in revised form 25 June 2008; accepted 15 July 2008.

Abstract

Objective

To retrospectively study the outcomes of vestibular schwannoma (VS) resection.

Methods

Between January 2003 and December 2006, 103 consecutive patients who had undergone VS resection were included in this study. Medical records, operation summaries, follow-up data, and neuroradiological findings were analyzed. The relationship between tumor size, location, and topography relative to the facial nerve bundles was studied for a mean duration of 16 months (range: 3–39 months).

Results

Complete tumor resection in combination with anatomic preservation of the facial nerve was achieved in 101 (98.1%) cases. The facial nerve was fully preserved in 100% of cases with small or medium tumors and in 37/39 patients with large tumors. Overall, 83.5% of patients had normal or near-normal facial nerve function 3–12 months post-surgically. The mortality rate was 0%.

Conclusions

Even in large VS, preservation of facial nerve function (H-B Grade I or II) should be prioritized over total resection. For tumors >3cm, the goal of low morbidity and maintenance of normal facial nerve function can be attained with the retrosigmoid transmeatal approach, refined microsurgical technique, and intraoperative facial nerve monitoring.