title: Efficacy of facial nerve-sparing approach in patients with vestibular schwannomas.
abstract: OBJECTIVE
  The goal of this article was to show that a combination of facial nerve-sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS).
  
  
  METHODS
  Records of individuals treated by a single surgeon with a facial nerve-sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.2%) of these patients required postoperative retreatment for a significant expansion of residual tumor after microsurgery. These 20 patients were re-treated with GKS.
  
  
  RESULTS
  The rate of preservation of good facial nerve function (Grade I or II on the House-Brackmann scale) in patients treated with microsurgery for VS was 97%. Both subtotal and gross-total resection had excellent facial nerve preservation rates (97% vs 96%), although subtotal resection carried a higher risk that patients would require retreatment. In patients re-treated with GKS after microsurgery, the rate of facial nerve preservation was 95%.
  
  
  CONCLUSIONS
  In patients with tumors that cannot be managed with radiosurgery alone, a facial nerve-sparing resection followed by GKS for any significant regrowth provides excellent facial nerve preservation rates.
authors.affiliation: Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, and The Neurological Institute of New York, New York, USA.
authors.forename: Raqeeb
authors.initials: R
authors.lastname: Haque
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Wojtasiewicz
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gigante
authors.forename: Mark A
authors.initials: MA
authors.lastname: Attiah
authors.forename: Brendan
authors.initials: B
authors.lastname: Huang
authors.forename: Steven R
authors.initials: SR
authors.lastname: Isaacson
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sisti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005154:Facial Nerve / Q000503:physiopathology* / Q000601:surgery; D020220:Facial Nerve Injuries / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000503:physiopathology / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome