Preservation of facial nerve function after postoperative vasoactive treatment in vestibular schwannoma surgery.
OBJECTIVE
Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experimental and clinical studies point to a beneficial effect of nimodipine and hydroxyethyl starch for preservation of cochlear nerve function. A retrospective analysis was undertaken to evaluate the effect of vasoactive treatment on facial nerve outcome.


METHODS
Forty-five patients with vestibular schwannoma removal, intraoperative electromyographic monitoring, and postoperative deterioration of facial nerve function were evaluated. Twenty-five patients underwent vasoactive treatment consisting of nimodipine and hydroxyethyl starch for improvement of hearing outcome. Twenty patients did not receive such treatment. Facial nerve function was evaluated before and after surgery, as well as 1 year after the surgical procedure. Patients were comparable regarding age, tumor size, and preoperative facial nerve function.


RESULTS
Long-term results of facial nerve function were significantly improved in those patients who experienced severe postoperative deterioration of facial nerve function and received vasoactive treatment as compared with patients who did not receive nimodipine and hydroxyethyl starch after surgery. Treated patients showed a significantly higher rate of complete recovery compared with patients without treatment.


CONCLUSIONS
The study points to a potential effect of vasoactive treatment for facial nerve function after vestibular schwannoma surgery. In particular, patients with postoperative disfiguring facial nerve palsy clearly benefit from intravenous hydroxyethyl starch and nimodipine with respect to a long-term socially acceptable facial nerve function.
Strauss
Christian
C
Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany. christian-strauss@medizin.uni-halle.de
Romstöck
Johann
J
Fahlbusch
Rudolf
R
Rampp
Stefan
S
Scheller
Christian
C
D000328:Adult; D000368:Aged; D005154:Facial Nerve / Q000187:drug effects* / Q000502:physiology*; D020220:Facial Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009464:Neuroma, Acoustic / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*
D014665:Vasodilator Agents