title: Outcome after translabyrinthine surgery for vestibular schwannomas: report on 1244 patients.
abstract: The objective of this article is to study the outcome after translabyrinthine surgery for vestibular schwannomas, with special focus on the facial nerve function. The study design is a case series from a national centralized database and it is set in two University Hospitals in Denmark. Participants were 1244 patients who underwent translabyrinthine surgery during a period of 33 years from 1976 to 2009. Main outcome measures were tumor removal, intraoperative facial nerve preservation, complications, and postoperative facial nerve function. In 84% patients, the tumor was totally resected and in ~85% the nerve was intact during surgery. During 33 years, 12 patients died from complications to surgery and ~14% had cerebrospinal fluid leakage. Before surgery, 74 patients had facial paresis and 46% of these improved after surgery. In patients with normal facial function, overall ~70% had a good outcome (House-Brackmann grade 1 or 2). The chance of a good outcome was related to tumor size with a higher the chance the smaller the tumor, but not to the degree of tumor removal. In ~78% of the patients with facial paresis at discharge the paresis improved over time, in ~42% from a poor to a good function. The translabyrinthine approach is generally efficient in tumor control and with satisfactory facial nerve outcome. With larger tumors the risk of a poor outcome is evident and more data on patients managed with alternative strategies are warranted.
authors.affiliation: University Clinic of Neurosurgery, Copenhagen University Hospital, Copenhagen Ø, Denmark.
authors.forename: Jacob Bertram
authors.initials: JB
authors.lastname: Springborg
authors.forename: Kåre
authors.initials: K
authors.lastname: Fugleholm
authors.forename: Lars
authors.initials: L
authors.lastname: Poulsgaard
authors.forename: Per
authors.initials: P
authors.lastname: Cayé-Thomasen
authors.forename: Jens
authors.initials: J
authors.lastname: Thomsen
authors.forename: Sven-Eric
authors.initials: SE
authors.lastname: Stangerup
keywords: facial nerve; outcome; translabyrinthine surgery; vestibular schwannoma