Clinical study| Volume 12, ISSUE 4, P405-408, May 2005

Download started.


Facial nerve function after excision of large acoustic neuromas via the suboccipital retrosigmoid approach


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Matula C.
        • Diaz Day J.
        • Czech T.
        • Koos W.T.
        The retrosigmoid approach to acoustic neurinomas: technical, strategic, and future concepts.
        Acta Neurochir (Wien). 1995; 134: 139-147
        • Nadol Jr., J.B.
        • Levine R.
        • Ojemann R.G.
        • Martuza R.L.
        • Montgomery W.W.
        • de Sandoval P.K.
        Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle.
        Laryngoscope. 1987; 97: 1287-1294
        • Samii M.
        • Matthies C.
        Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve-preservation and restitution of function.
        Neurosurgery. 1997; 40: 684-694
        • Ebersold M.J.
        • Harner S.G.
        • Beatty C.W.
        • Harper Jr., C.M.
        • Quast L.M.
        Current results of the retrosigmoid approach to acoustic neurinoma.
        J Neurosurg. 1992; 76: 901-909
        • Samii M.
        • Matthies C.
        Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections.
        Neurosurgery. 1997; 40: 248-260
        • Santamarta D.
        • Blazquez J.A.
        • Maillo A.
        • Munoz A.
        • Caballero M.
        • Morales F.
        Analysis of cerebrospinal fluid related complications (hydrocephalus, fistula, pseudo-meningocele and infection) following surgery for posterior fossa tumors.
        Neurocirugia (Astur). 2003; 14: 117-126
        • Kondziolka D.
        • Lunsford E.D.
        • McLaughlin M.R.
        • Flickinger J.C.
        Long-term outcomes after radiosurgery for acoustic neuromas.
        N Engl J Med. 1998; 339: 1426-1433
        • Ojemann R.G.
        Management of acoustic neuromas (vestibular schwannomas) (honored guest presentation).
        Clin Neurosurg. 1993; 40: 498-535
        • Lalwani A.K.
        • Butt F.Y.
        • Jackler R.K.
        • Pitts L.H.
        • Yingling C.D.
        Facial nerve outcome after acoustic neuroma surgery: a study from the era of cranial nerve monitoring.
        Otolaryngol Head Neck Surg. 1994; 11: 561-570
        • Mamikoglu B.
        • Wiet R.J.
        • Esquivel C.R.
        Translabyrinthine approach for the management of large and giant vestibular schwannomas.
        Otol Neurotol. 2002; 23: 224-227
        • Rowed D.W.
        • Nedzelski J.M.
        Hearing preservation in the removal of intracanalicular acoustic neuromas via the retrosigmoid approach.
        J Neurosurg. 1997; 86: 456-461
        • Somers T.
        • Offeciers F.E.
        • Schatteman I.
        Results of 100 vestibular schwannoma operations.
        Acta Otorhinolaryngol Belg. 2003; 57: 155-166
        • Mamikoglu B.
        • Esquivel C.R.
        • Wiet R.J.
        Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in medium-sized tumors.
        Arch Otolaryngol Head Neck Surg. 2003; 129: 429-431
        • Tos M.
        • Thomsen J.
        • Harmsen A.
        Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size.
        Acta Otolaryngol (Suppl). 1988; 452: 38-51
        • House J.
        • Brackmann D.
        Facial nerve grading system.
        Otolaryngol Head Neck Surg. 1985; 93: 146-147
        • Lanman T.H.
        • Brackmann D.E.
        • Hitselberger W.E.
        • Subin B.
        Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach.
        J Neurosurg. 1999; 90: 617-623
        • Zhang X.
        • Zhang J.
        • Fei Z.
        • et al.
        Preservation of facial nerve function during microsurgical removal of large acoustic neuroma.
        Chin J Neurosurg Dis Res. 2002; 1: 116-119
        • Grey P.L.
        • Moffat D.A.
        • Palmer C.R.
        • Hardy D.G.
        • Baguley D.M.
        Factors which influence the facial nerve outcome in vestibular schwannoma surgery.
        Clin Otolaryngol. 1996; 21: 409-413
        • Iwai Y.
        • Yamanaka K.
        • Ishiguro T.
        Surgery combined with radiosurgery of large acoustic neuromas.
        Surg Neurol. 2003; 59: 283-289
        • Yokoyama T.
        • Uemura K.
        • Ryu H.
        Facial nerve monitoring by monopolar low constant current stimulation during acoustic neurinoma surgery.
        Surg Neurol. 1991; 36: 12-18
        • Kondziolka D.
        • Lunsford E.D.
        • Flickinger J.C.
        Acoustic tumors: operation versus radiation-making sense of opposing viewpoints. Part II. Acoustic neuromas: sorting out management options.
        Clin Neurosurg. 2003; 50: 313-328
        • Donzelli R.
        • Motta G.
        • Cavallo E.M.
        • Maiuri F.
        • De Divitiis E.
        One-stage removal of residual intracanalicular acoustic neuroma and hemihypoglossal-intratemporal facial nerve anastomosis: technical note.
        Neurosurgery. 2003; 53: 1444-1447