title: Facial nerve outcomes in functional vestibular schwannoma surgery: less than total tumour excision significantly improves results.
abstract: OBJECTIVE
  To determine the implications of a functional approach to vestibular schwannoma surgery, with facial nerve function prioritised higher than total tumour excision.
  
  
  METHODS
  A case-control study in a tertiary referral neurotology clinic.
  
  
  METHODS
  A 'functional' surgical group treated after April 2007 (n = 44, mean cerebellopontine angle dimension 27 mm), and an 'excisional' surgical group matched for tumour size, treated from 1997 to April 2007 (n = 115).
  
  
  METHODS
  Change to more functional surgical approach.
  
  
  METHODS
  
  
  
  METHODS
  facial nerve status. Secondary outcome: tumour recurrence in less-than-total tumour excision.
  
  
  RESULTS
  Facial nerve preservation: 77 per cent House-Brackmann grade I-II in functional group at 12 months, versus 57 per cent grade I-II in excisional group (p = 0.027). Tumour recurrence: 1 per cent in total excision group, 2 per cent in near-total group and 40 per cent in sub-total group.
  
  
  CONCLUSIONS
  A functional approach to vestibular schwannoma surgery improves facial nerve preservation outcomes and reduces the requirement for facial nerve rehabilitative interventions. Tumour recurrence rates are low in near-totally excised lesions but significant if only sub-total excision is achieved.
authors.affiliation: Department of ENT, Queen Elizabeth Hospital, Birmingham, UK. tpcmartin001@gmail.com
authors.forename: T P C
authors.initials: TP
authors.lastname: Martin
authors.forename: H
authors.initials: H
authors.lastname: Fox
authors.forename: E-C
authors.initials: EC
authors.lastname: Ho
authors.forename: R
authors.initials: R
authors.lastname: Holder
authors.forename: R
authors.initials: R
authors.lastname: Walsh
authors.forename: R M
authors.initials: RM
authors.lastname: Irving
mesh_terms: D016022:Case-Control Studies; D003390:Cranial Nerve Neoplasms / Q000503:physiopathology* / Q000601:surgery; D005154:Facial Nerve / Q000503:physiopathology*; D005158:Facial Paralysis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009464:Neuroma, Acoustic / Q000503:physiopathology* / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000379:methods* / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011184:Postoperative Period