title: The learning curve in vestibular schwannoma surgery.
abstract: OBJECTIVE
  This study aimed to examine the effect of surgical team experience on facial nerve function and complication rate in vestibular schwannoma surgery.
  
  
  METHODS
  The study design was a retrospective analysis of a case series.
  
  
  METHODS
  The study was conducted at a tertiary referral center.
  
  
  METHODS
  One hundred sixty consecutive patients undergoing vestibular schwannoma excision participated.
  
  
  METHODS
  Surgical excision of vestibular schwannoma via a translabyrinthine, middle cranial fossa, suboccipital, or combined approach was performed.
  
  
  METHODS
  Facial nerve function (House-Brackmann score) and complication rates including cerebrospinal fluid leak and meningitis compared by groups of 20 patients were measured.
  
  
  RESULTS
  There was a statistically significant improvement in the number of patients achieving a House-Brackmann grade I result between the first 20 patients (35% House-Brackmann grade 1) and the ensuing 7 groups of 20 patients (74% House-Brackmann grade 1) by chi2 analysis. When considering House grades I and II together, there was no statistically significant difference in facial nerve function in the first 20 patients (80%) compared to the last 7 groups of 20 patients (88%) by Tukey's pairwise comparisons (p = 0.245). Mean tumor size was not significantly different in the groups studied (p = 0.54). The total cost of patient care declined over the study period; however, the wide case-to-case variance made it so that this trend was not statistically significant (p = 0.448).
  
  
  CONCLUSIONS
  A learning curve of 20 patients was demonstrated by this study to have been necessary for attaining acceptable standards in the surgical removal of vestibular schwannomas by a new surgical team. The findings of this study may have implications for patient care and surgeon training.
authors.affiliation: Department of Otolaryngology, The Ohio State University, Columbus 43210, USA.
authors.forename: D B
authors.initials: DB
authors.lastname: Welling
authors.forename: P W
authors.initials: PW
authors.lastname: Slater
authors.forename: R D
authors.initials: RD
authors.lastname: Thomas
authors.forename: J M
authors.initials: JM
authors.lastname: McGregor
authors.forename: J E
authors.initials: JE
authors.lastname: Goodman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D002648:Child; D002983:Clinical Competence / Q000592:standards*; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007858:Learning; D008297:Male; D008581:Meningitis / Q000209:etiology; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D010036:Otolaryngology / Q000193:education*; D013506:Otologic Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies