title: Improved facial nerve outcomes using an evolving treatment method for large acoustic neuromas.
abstract: OBJECTIVE
  To describe a successful paradigm for the treatment of large acoustic neuromas (vestibular schwannomas).
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  The charts of 2,875 acoustic neuroma patients at Michigan Ear Institute were reviewed to identify 153 patients who underwent surgical resection for large acoustic neuromas (>=3 cm) between 2000 and 2009.
  
  
  METHODS
  Staged surgical resection or single stage surgery with or without adjuvant stereotactic radiosurgery.
  
  
  METHODS
  Postoperative facial nerve outcomes are reported using the House-Brackmann (HB) facial nerve grading scale and compared with historical controls from a literature review. Rates of adverse outcomes are also reported.
  
  
  RESULTS
  Seventy-five patients underwent staged surgical resection of their tumors, whereas 78 patients underwent either single stage surgery or surgery with subsequent stereotactic radiosurgery. Eighty-one percent of patients in the staged surgical resection group had a postoperative HB Grade I or II facial nerve function compared with 75% in the single stage surgical group. Overall, 78% of patients in the current study had HB Grade I or II after treatment compared with a mean of 53% in the literature for similar sized tumors. Our methods including the decision to use staged surgery when necessary, dissection of tumor with stimulating dissector-directed intraoperative monitoring, and use of adjuvant stereotactic radiosurgery are described.
  
  
  CONCLUSIONS
  Using the described paradigm, large acoustic neuromas can be successfully treated with either staged or single-stage surgical resection with or without adjuvant radiosurgery to obtain more favorable facial nerve outcomes than historically reported controls while minimizing morbidity for the patient.
authors: Michigan Ear Institute, 30055 Northwestern Highway, Farmington Hills, MI 48334, USA.
authors: Ryan G
authors: RG
authors: Porter
authors: Michael J
authors: MJ
authors: LaRouere
authors: Jack M
authors: JM
authors: Kartush
authors: Dennis I
authors: DI
authors: Bojrab
authors: Daniel R
authors: DR
authors: Pieper
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002530:Cerebellopontine Angle / Q000601:surgery; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology; D003131:Combined Modality Therapy; D004129:Dimethylpolysiloxanes; D004432:Ear, Middle / Q000601:surgery; D005064:Eustachian Tube / Q000601:surgery; D005154:Facial Nerve / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D016634:Radiosurgery; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon