title: Recurrence rate, time to progression and facial nerve function in microsurgery of vestibular schwannoma.
abstract: OBJECTIVE
  Recurrence rate, time to progression, and facial nerve function were analysed by comparing patients with complete and near total tumor removal after suboccipital craniotomy for vestibular schwannoma surgery.
  
  
  METHODS
  From 1996 to 2004, 118 patients with vestibular schwannoma were operated with an interdisciplinary approach. Fifty patients fulfilled the inclusion criteria and were included in the study. Progression was defined as an increase of ⩾2 mm in the largest diameter in the magnetic resonance imaging. Preoperative tumor size, facial nerve function estimated using the House-Brackmann score (HBS), time to progression, and recurrence rate were analysed and related to the extent of resection.
  
  
  RESULTS
  In 28 cases (group I), a capsular remnant was left. In 22 cases (group II), tumor removal was complete. In group I, nine patients (32·1%) showed progression. In group II, two patients (9·1%) developed a recurrent tumor, no significance (P = 0·085). In groups I and II, 53·6 and 59·6% had a good function of the facial nerve (HBS I+II), 28·6% in group I and 13·5% in group II had a moderate disturbance (HBS III+IV), and 17·9% in group I and 27·7% in group II had a poor function (HBS V+VI). There was no significant difference between median preoperative tumor size and facial nerve function within patients with HBS III and IV.
  
  
  CONCLUSIONS
  Complete tumor removal may be associated with a risk of functional loss, whereas near total tumor removal may be associated with a higher risk of progression.
authors.affiliation: Department of Neurosurgery, University Hospital Leipzig, Germany. felix.arlt@medizin.uni-leipzig.de
authors.forename: F
authors.initials: F
authors.lastname: Arlt
authors.forename: C
authors.initials: C
authors.lastname: Trantakis
authors.forename: V
authors.initials: V
authors.lastname: Seifert
authors.forename: F
authors.initials: F
authors.lastname: Bootz
authors.forename: G
authors.initials: G
authors.lastname: Strauss
authors.forename: J
authors.initials: J
authors.lastname: Meixensberger
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D020220:Facial Nerve Injuries / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009464:Neuroma, Acoustic / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome