Volume 29, Issue 5, 2020
DOI: 10.24205/03276716.2020.1085
Multimodal Approach for Maximizing Facial Nerve Reservation in Large Acoustic Neuroma Surgery
Abstract
Objective: To investigate technologies and methods for facial nerve function preservation during a large acoustic neuroma surgery.
Methods: Fifty-eight patients with large acoustic neuromas were recruited in the study. Each patient was treated by a microsurgery applied with suboccipital retrosigrnoid transmeatus approach under neurophysiological monitoring. All patients were followed up for one year and received post-surgical facial nerve function evaluation at post-surgery 7d and 90d.Retrospective analysis was carried out on the patients’ clinical data and evaluations of treatment efficacy.
Results: A complete resection of the acoustic Neuroma was achieved in 39 patients (67.2%). while 13 case (22.4%) received subtotal resection and 6 cases (10.3%) received partial resection. Facial nerve anatomical preservation was achieved in all patients. Facial nerve H-B classification changes varied at different time point. post-surgical 7d: 9 cases Facial nerve H-B classification stayed at the same grade, 19 cases changed 1 grade, 18 cases changed 2 grade, 10 cases changed 3 grade, and 2 cases changed 4 grade; post-surgical 90d: 16 cases Facial nerve H-B classification stayed at the same grade, 19 cases changed 1 grade, 21 cases changed 2 grade, and 2 cases changed 3 grade. Pre-surgical tumor diameter showed significantly positive correlation with the Facial nerve H-B classification changes at post-surgical 7d (Pearson’s Correlation，p <0.001) and 90d (Pearson’s Correlation，p =0.007). As a result, Larger pre-surgical tumor diameter indicated worse prognosis of post-surgical facial nerve function(p<0.05).
Conclusions: Meticulous microsurgical operation and consummate neurophysiological monitoring assistance are of great value for intraoperative facial nerve preservation. Pre-surgical tumor diameter can be used as a predictor of post-surgical facial nerve function prognosis.
Keywords
Large acoustic neuroma; Facial nerve; Neurophysiological monitoring; Tumor diameter