title: Facial nerve function after excision of large acoustic neuromas via the suboccipital retrosigmoid approach.
abstract: We review our results for facial nerve preservation in 105 patients with large acoustic neuromas (diameter 4.0 cm or larger) undergoing excision via the suboccipital retrosigmoid approach. Microneurosurgical techniques and facial nerve monitoring were used. Complete tumor removal was achieved in 91 cases (86.7%) and subtotal removal in 14 (13.3%). There were two postoperative deaths (1.9%). The facial nerve was preserved anatomically in 83 (79.1%) patients. Using the House-Brackmann grading system, facial nerve function was assessed immediately after surgery, at the time of discharge and 1 year after surgery. Excellent function (Grades I and II) was present in 41.0%, 41.8%, and 56.7% of patients at each time interval, respectively, with acceptable function (Grade I-IV) in 78.5% (68/87 cases) at follow-up assessment at one year. The suboccipital retrosigmoid approach resulted in good anatomical and functional preservation of the facial nerve during excision of large acoustic neuromas, with minimal other morbidity and low mortality. We recommend this approach for excision of large acoustic neuromas.
authors.affiliation: Department of Neurosurgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, PR China. xzhang@fmmu.edu.cn
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhang
authors.forename: Zhou
authors.initials: Z
authors.lastname: Fei
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Chen
authors.forename: Luo-An
authors.initials: LA
authors.lastname: Fu
authors.forename: Jian-Ning
authors.initials: JN
authors.lastname: Zhang
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Liu
authors.forename: Xiao-Sheng
authors.initials: XS
authors.lastname: He
authors.forename: Xiao-Fan
authors.initials: XF
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D005154:Facial Nerve / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D009777:Occipital Bone / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome