Staged resection of large acoustic neuromas.
OBJECTIVE
Surgical removal of large (>3 cm) acoustic neuromas is associated with poor long-term facial nerve function results and higher complication rates. This study analyzes whether long term facial nerve function and the incidence of neurological and vascular complications is improved by resection of large acoustic neuromas in 2 or 3 stages.


METHODS
Among 660 patients who underwent surgical resection of acoustic neuromas between 1989 and 2002 by the senior author (J.M.K.), 34 (5%) patients underwent a staged resection of their large-sized tumors: stage I via a retrosigmoid craniotomy and stage II via a translabyrinthine approach. A retrospective chart review was performed. Tumor size, completeness of tumor removal, tumor recurrence, facial nerve function, and any complications were noted.


RESULTS
The average tumor size was 4.4 cm with a mean postoperative length of follow-up of 6 years after the last surgery. Thirty-one patients underwent a 2-staged resection and 3 patients underwent a 3-staged resection. After their last surgery, 32 (94%) patients had excellent long-term facial function grades of House-Brackmann (H-B) I, one was H-B III, and one was H-B VI. All patients had a total or near-total (>98%) resection. There were no tumor recurrences on follow-up MRI scans. From these 71 operations, no patients required reoperation for a CSF leak. There were no deaths, strokes, hydrocephalus, or meningitis.


CONCLUSIONS
In conjunction with the reported technical refinements, staged resection of large tumors significantly reduces morbidity and improves long-term facial nerve function.


METHODS
C.
Patni
Aftab H
AH
Michigan Ear Institute, Farmington Hills 48334, USA.
Kartush
Jack M
JM
D005154:Facial Nerve / Q000502:physiology; D005155:Facial Nerve Diseases / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies