Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannomaReport as inadecuate




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Journal of Neuro-Oncology

, Volume 102, Issue 2, pp 281–286

First Online: 06 August 2010Received: 15 February 2010Accepted: 12 July 2010

Abstract

Avoidance of facial nerve palsy is one of the major goals of vestibular schwannoma VS microsurgery. In this study, we examined the significance of previously implicated prognostic factors age, tumor size, the extent of resection and the surgical approach on post-operative facial nerve function. We selected all VS patients from prospectively collected database 1984–2009 who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. The effect of variables such as surgical approach, tumor size, patient age and extent of resection on rates facial nerve dysfunction after surgery, were analyzed using multivariate logistic regression. Patients with preoperative facial nerve dysfunction House-Brackman HB score 3 or higher were excluded, and HB grade of 1 or 2 at the last follow-up visit was defined as -facial nerve preservation.- A total of 624 VS patients were included in this study. Multivariate logistic regression analysis found that only pre-operative tumor size significantly predicted poorer facial nerve outcome for patients followed-up for ≥6 and ≥12 months OR 1.27, 95% CI 1.09–1.49, p < 0.01; OR 1.35, 95% CI 1.10–1.67, P < 0.01, respectively. We found no significant relationship between facial nerve function and age, extent of resection, surgical approach, or tumor size when extent of resection and surgical approach were included in the regression analysis. Because facial nerve palsy is a debilitating and psychologically devastating condition for the patient, we suggest altering surgical aggressiveness in patients with unfavorable tumor anatomy, particularly in cases with large tumors where overaggressive resection might subject the patient to unwarranted risk. Residual disease can be followed and controlled with radiosurgery if interval growth is noted.

KeywordsVestibular schwannoma Acoustic neuroma Microsurgery Facial nerve function Facial nerve palsy  Download fulltext PDF



Author: Orin Bloch - Michael E. Sughrue - Rajwant Kaur - Ari J. Kane - Martin J. Rutkowski - Gurvinder Kaur - Isaac Yang - Lawre

Source: https://link.springer.com/







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