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Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery

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Abstract

Objective

The paper aims to define the parameters available before surgery which could predict immediate facial nerve function after excision of a vestibular schwannoma (VS).

Methods

Ninety-nine patients with VS operated consecutively by a single surgeon using an identical surgical technique have been evaluated retrospectively. Data were collected regarding patients' sex, age at onset of symptoms and at surgery, initial symptoms, neurological status at presentation, early post-operative neurological status and complications. The main radiological parameters included in the study were tumour extension pattern, diameters, shape, and volume, as well as extent of bony changes of the internal auditory canal.

Results

As the tumour stage and volume increase, facial nerve function is worse after surgery (p < 0.001 and p < 0.05, respectively). Concomitantly, larger extra-meatal tumour diameters in three dimensions (sagittal, coronal and axial) led to worse function (p < 0.01). Anterior and/or caudal tumour extension (p = 0.001 and p = 0.004, respectively) had more significant correlation than posterior and/or cranial extension (p = 0.022 and p = 0.353, respectively). Polycyclic VS had the worst prognosis, followed by the tumours with oval shape. The extent of intra-meatal tumour growth does not correlate with immediate facial nerve outcome. The different angles, lengths and diameters of the internal auditory channel showed no significant correlation with facial nerve outcome. Patients with headache as an initial symptom and those with gait instability and/or pre-operative poor facial nerve function had significantly worse immediate facial nerve outcome.

Conclusion

Our data suggests that the analysis of the radiological and neurological patient data prior to surgery could give reliable clues regarding the immediate post-operative facial nerve function.

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Author information

Authors and Affiliations

  1. International Neuroscience Institute—Hannover, Rudolf Pichlmayr Str. 4, Hannover, 30625, Germany

    Venelin Miloslavov Gerganov, Petra Margarete Klinge, Lennart Stieglitz, Madjid Samii & Amir Samii

  2. Tehran University of Medical Sciences, Tehran, Iran

    Mohsen Nouri

Authors
  1. Venelin Miloslavov Gerganov
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  2. Petra Margarete Klinge
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  3. Mohsen Nouri
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  4. Lennart Stieglitz
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  5. Madjid Samii
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  6. Amir Samii
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Corresponding author

Correspondence to Venelin Miloslavov Gerganov.

Additional information

This is an interesting analysis of the prognostic factors for facial nerve outcome after vestibular schwannoma surgery. Preoperative clinical and radiological parameters were correlated with the outcome at two weeks postoperatively. Main negative factors were large size and direction of the tumor expansion, cystic structure and preexistig facial dysfunction.

Although these results are not all new the paper summarizes the important aspects well. In comparison to other articles the analysis comprises a homogeneous group of patients, almost 100 patients operated upon by one surgeon witnin one and a half year. The paper is well written and the pertinent literature is reflected.

H.J. Steiger

University of Düsseldorf

Facial Nerve Function following vestibular schwannoma surgery

The authors review a recent series of 99 patients with vestibular schwannomas who had tumor resection by Professor Samii via the retrosigmoid approach. They have specifically reviewed those preoperative clinical and imaging characteristics which could have been associated with facial nerve functional outcomes. They note that tumor size, especially larger extrameatal tumor volume,negatively impacted facial nerve outcome. Anterior extent of tumor was also negatively associated. Intrameatal tumor shape and size was not associated with outcome. Not surprisingly, gait instability and preoperative facial nerve dysfunction were associated with a poorer facial nerve outcome.Overall, these results are somewhat intuitive, however the strength of the submission was the uniformity of surgical factors, and experience of the surgical team which reduces these other variables relating to facial nerve outcome.

W.T. Couldwell

USA

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Gerganov, V.M., Klinge, P.M., Nouri, M. et al. Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery. Acta Neurochir 151, 581–587 (2009). https://doi.org/10.1007/s00701-009-0288-3

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  • DOI: https://doi.org/10.1007/s00701-009-0288-3

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