Acoustic neuroma surgery as an interdisciplinary approach: a neurosurgical series of 508 patients.
OBJECTIVE
To evaluate an interdisciplinary concept (neurosurgery/ear, nose, and throat (ENT)) of treating acoustic neuromas with extrameatal extension via the retromastoidal approach. To analyse whether monitoring both facial nerve EMG and BAEP improved the functional outcome in acoustic neuroma surgery.


METHODS
In a series of 508 patients consecutively operated on over a period of 7 years, functional outcome of the facial nerve was evaluated according to the House/Brackmann scale and hearing preservation was classified using the Gardner/Robertson system.


RESULTS
Facial monitoring (396 of 508 operations) and continuous BAEP recording (229 of 399 cases with preserved hearing preoperatively) were performed routinely. With intraoperative monitoring, the rate of excellent/good facial nerve function (House/Brackmann I-II) was 88.7%. Good functional hearing (Gardner/Robertson 1-3) was preserved in 39.8%.


CONCLUSIONS
Acoustic neuroma surgery via a retrosigmoidal approach is a safe and effective treatment for tumours with extrameatal extension. Functional results can be substantially improved by intraoperative monitoring. The interdisciplinary concept of surgery performed by ENT and neurosurgeons was particularly convincing as each pathoanatomical phase of the operation is performed by a surgeon best acquainted with the regional specialties.
Tonn
J C
JC
Department of Neurosurgery University of Wuerzburg, Josef- Schneider-Strasse 11, D-97080 Wuerzburg, Germany. tonn@mail.uni-wuerzburg.de
Schlake
H P
HP
Goldbrunner
R
R
Milewski
C
C
Helms
J
J
Roosen
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D016057:Evoked Potentials, Auditory, Brain Stem; D005154:Facial Nerve / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010348:Patient Care Team; D011183:Postoperative Complications / Q000517:prevention & control; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome