title: Intraoperative neuromonitoring for removal of large vestibular schwannoma: Facial nerve outcome and predictive factors.
abstract: BACKGROUND
  Preservation of facial nerve (FN) function is one of the major goals for resection of large vestibular schwannoma (VS) (≥ 30 mm). Little is known about the FN outcome and its predictive factors due to limited data.
  
  
  OBJECTIVE
  To explore the predictive factors affecting FN outcome following resection of large VS.
  
  
  METHODS
  106 Large VS patients underwent surgical resection from 2010 to 2012 via intraoperative neuromonitoring for FN preservation approach. Postoperative FN function evaluation was conducted at the time points of 3-7th day, 3rd month and at the end of the 2nd year. Correlation between tumor size, intraoperative parameters and FN function were examined.
  
  
  RESULTS
  The ratios of total and subtotal resection were 82.1% and 14.2%, respectively. Acceptable FN function was achieved in 78% patients. Patients with good FN function showed much smaller (P < 0.01) VS size than those of poor-FN function patients at 3-7th day, 3rd month and 2nd year. There was a significant correlation between facial motor evoked potential (FMEP) ratios and postoperative FN function at 3-7th day (r = -0.709, P < 0.001) 3rd month (r = -0.709, P< 0.001) and 2nd year (r = -0.750, P < 0.001). Maximal response amplitude (MRA) ratio was a supplementary indicator for train time in predicting both immediate and long-term FN function in patients with large VS.
  
  
  CONCLUSIONS
  Indicative factors of both immediate and long-term postoperative FN function in large VSs include tumor size, intraoperative train time, start to final FMEP ratios and proximal to distal MRA ratios.
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Sheng-wen
authors: SW
authors: Liu
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: dr.jiangwei@tjh.tjmu.edu.cn.
authors: Wei
authors: W
authors: Jiang
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Hua-qiu
authors: HQ
authors: Zhang
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Xiao-peng
authors: XP
authors: Li
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Xue-yan
authors: XY
authors: Wan
authors: Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Bosomah
authors: B
authors: Emmanuel
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Kai
authors: K
authors: Shu
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Jing-cao
authors: JC
authors: Chen
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Jian
authors: J
authors: Chen
authors: Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Ting
authors: T
authors: Lei
mesh_terms: D000328:Adult; D000368:Aged; D005154:Facial Nerve / Q000502:physiology*; D020220:Facial Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D017063:Outcome Assessment, Health Care; D011379:Prognosis
keywords: Facial nerve; Intraoperative neuromonitoring; Large vestibular schwannoma; Microsurgery; Predictive factors