Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in medium-sized tumors.
OBJECTIVE
To compare postoperative facial nerve function results according to surgical approach.


METHODS
Retrospective case review study.


METHODS
All surgical procedures were conducted in collaboration with a neurosurgery team in teaching hospitals with an academic affiliation.


METHODS
Patients with medium to large vestibular schwannomas, with the tumor size ranging from 2 to 3 cm. Ninety-eight patients were identified from an "Acoustic Neuroma Database" (date range of search, 1983-2000).


METHODS
The House-Brackmann scale was used for grading facial function in the immediate postoperative period and 1 year after. Guidelines of the American Academy of Otolaryngology-Head and Neck Surgery were used for classification of hearing preservation.


RESULTS
Of the 98 patients, 17 were operated on through a retrosigmoid approach and 81 through the translabyrinthine route. The mean +/- SD ages of these 2 groups of patients were 46 +/- 13 and 51 +/- 14 years, respectively; mean +/- SD tumor sizes were 2.5 +/- 0.27 and 2.6 +/- 0.28 cm, respectively. One year after tumor removal via retrosigmoid approach, 10 (59%) of the 17 patients had good (grade I-II) facial functions and 2 (12%) had poor (grade V-VI) function. In the translabyrinthine group, 54 (68%) of 79 patients (2 patients had subtotal total tumor removal) had good facial nerve function at the end of the 1-year follow-up, and 13 (17%) continued to have poor facial function. The difference between these groups was not statistically significant (P>.05). Hearing was preserved in 4 (24%) of the 17 patients in the retrosigmoid group.


CONCLUSIONS
Although the translabyrinthine approach may offer better long-term facial function compared with the retrosigmoid approach in patients with medium-sized tumors, the difference between these 2 groups was not significant enough to favor one approach over the other.
Mamikoglu
Bulent
B
Division of Otolaryngology/Neurotology and Evanston Research Institute, Evanston Northwestern Healthcare, Evanston, IL, USA.
Esquivel
Carlos R
CR
Wiet
Richard J
RJ
D000328:Adult; D000368:Aged; D001299:Audiometry; D007758:Ear, Inner / Q000503:physiopathology* / Q000601:surgery*; D005154:Facial Nerve / Q000503:physiopathology* / Q000601:surgery*; D005155:Facial Nerve Diseases / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000503:physiopathology* / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors