Summary
We review our results for facial nerve preservation in 105 patients with large acoustic
neuromas (diameter 4.0 cm or larger) undergoing excision via the suboccipital retrosigmoid approach. Microneurosurgical
techniques and facial nerve monitoring were used. Complete tumor removal was achieved
in 91 cases (86.7%) and subtotal removal in 14 (13.3%). There were two postoperative
deaths (1.9%). The facial nerve was preserved anatomically in 83 (79.1%) patients.
Using the House–Brackmann grading system, facial nerve function was assessed immediately
after surgery, at the time of discharge and 1 year after surgery. Excellent function
(Grades I and II) was present in 41.0%, 41.8%, and 56.7% of patients at each time
interval, respectively, with acceptable function (Grade I–IV) in 78.5% (68/87 cases)
at follow-up assessment at one year. The suboccipital retrosigmoid approach resulted
in good anatomical and functional preservation of the facial nerve during excision
of large acoustic neuromas, with minimal other morbidity and low mortality. We recommend
this approach for excision of large acoustic neuromas.
Keywords
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References
- The retrosigmoid approach to acoustic neurinomas: technical, strategic, and future concepts.Acta Neurochir (Wien). 1995; 134: 139-147
- Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle.Laryngoscope. 1987; 97: 1287-1294
- Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve-preservation and restitution of function.Neurosurgery. 1997; 40: 684-694
- Current results of the retrosigmoid approach to acoustic neurinoma.J Neurosurg. 1992; 76: 901-909
- Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections.Neurosurgery. 1997; 40: 248-260
- Analysis of cerebrospinal fluid related complications (hydrocephalus, fistula, pseudo-meningocele and infection) following surgery for posterior fossa tumors.Neurocirugia (Astur). 2003; 14: 117-126
- Long-term outcomes after radiosurgery for acoustic neuromas.N Engl J Med. 1998; 339: 1426-1433
- Management of acoustic neuromas (vestibular schwannomas) (honored guest presentation).Clin Neurosurg. 1993; 40: 498-535
- Facial nerve outcome after acoustic neuroma surgery: a study from the era of cranial nerve monitoring.Otolaryngol Head Neck Surg. 1994; 11: 561-570
- Translabyrinthine approach for the management of large and giant vestibular schwannomas.Otol Neurotol. 2002; 23: 224-227
- Hearing preservation in the removal of intracanalicular acoustic neuromas via the retrosigmoid approach.J Neurosurg. 1997; 86: 456-461
- Results of 100 vestibular schwannoma operations.Acta Otorhinolaryngol Belg. 2003; 57: 155-166
- Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in medium-sized tumors.Arch Otolaryngol Head Neck Surg. 2003; 129: 429-431
- Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size.Acta Otolaryngol (Suppl). 1988; 452: 38-51
- Facial nerve grading system.Otolaryngol Head Neck Surg. 1985; 93: 146-147
- Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach.J Neurosurg. 1999; 90: 617-623
- Preservation of facial nerve function during microsurgical removal of large acoustic neuroma.Chin J Neurosurg Dis Res. 2002; 1: 116-119
- Factors which influence the facial nerve outcome in vestibular schwannoma surgery.Clin Otolaryngol. 1996; 21: 409-413
- Surgery combined with radiosurgery of large acoustic neuromas.Surg Neurol. 2003; 59: 283-289
- Facial nerve monitoring by monopolar low constant current stimulation during acoustic neurinoma surgery.Surg Neurol. 1991; 36: 12-18
- Acoustic tumors: operation versus radiation-making sense of opposing viewpoints. Part II. Acoustic neuromas: sorting out management options.Clin Neurosurg. 2003; 50: 313-328
- One-stage removal of residual intracanalicular acoustic neuroma and hemihypoglossal-intratemporal facial nerve anastomosis: technical note.Neurosurgery. 2003; 53: 1444-1447
Article info
Publication history
Accepted:
March 23,
2004
Received:
February 2,
2004
Identification
Copyright
© 2005 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
