Facial nerve outcomes in functional vestibular schwannoma surgery: less than total tumour excision significantly improves results

作者：Martin T P C^*; Fox H; Ho E C; Holder R; Walsh R; Irving R M

来源：Journal of Laryngology and Otology, 2012, 126(2): 120-124.

DOI：10.1017/S0022215111003124

• Acoustic Neuroma
• Surgery
• Pathology
• Facial Nerve Paralysis

Objectives: To determine the implications of a functional approach to vestibular schwannoma surgery, with facial nerve function prioritised higher than total tumour excision. %26lt;br%26gt;Study design: A case-control study in a tertiary referral neurotology clinic. %26lt;br%26gt;Patients: A %26apos;functional%26apos; surgical group treated after April 2007 (n = 44, mean cerebellopontine angle dimension 27 mm), and an %26apos;excisional%26apos; surgical group matched for tumour size, treated from 1997 to April 2007 (n = 115). %26lt;br%26gt;Intervention: Change to more functional surgical approach. %26lt;br%26gt;Main outcomes measured: Primary outcome: facial nerve status. Secondary outcome: tumour recurrence in less-than-total tumour excision. %26lt;br%26gt;Results: Facial nerve preservation: 77 per cent House-Brackmann grade I-II in functional group at 12 months, versus 57 per cent grade I-II in excisional group (p = 0.027). Tumour recurrence: 1 per cent in total excision group, 2 per cent in near-total group and 40 per cent in sub-total group. %26lt;br%26gt;Conclusion: A functional approach to vestibular schwannoma surgery improves facial nerve preservation outcomes and reduces the requirement for facial nerve rehabilitative interventions. Tumour recurrence rates are low in near-totally excised lesions but significant if only sub-total excision is achieved.

• 出版日期2012-2