Facial functional outcome in monitored versus not-monitored patients in vestibular schwannomas surgery.
OBJECTIVE
Even though advances in surgical techniques have improved facial nerve outcomes, functional preservation is still an issue because injury to the facial nerve has significant physical and psychological consequences for the patient. We retrospectively review our data in VS surgery to compare the facial outcome in intraoperative facial monitored versus not-monitored patients.


METHODS
51 consecutive patients with unilateral vestibular schwannoma in the period from 2005 to 2010 were treated in our Institution. In according to the type of neurophysiological tool used during surgical procedures, two patients groups were identified: Group 1 (facial stimulator only) and Group 2 (stimulator and facial monitoring). Statistical comparison of the two groups was made with the t- test, and facial function results were evaluated with the Fisher's exact test.


RESULTS
In the Group 1, of the 22 patients with anatomically preserved facial nerves, 3 (13.6%) showed excellent facial nerve function, 14 (63.6%) showed intermediate function, and 5 (22.7%) showed poor function. In the Group 2, all the 27 patients got anatomically preserved facial nerves, and 18 (66.7%) showed excellent facial nerve function, 9 (33.3%) showed intermediate function, and no one showed poor function.


CONCLUSIONS
We found that retrosigmoid approach associated with continuous EMG facial monitoring combined with the use of bipolar stimulation is a safe and effective treatment for vestibular schwannomas.
Department of Neurosurgery, S. Salvatore Hospital, L'Aquila, Italy.
Graziano
G
Taddei
Department of Neurophysiopathology, S. Salvatore Hospital, L'Aquila, Italy.
Alfonso
A
Marrelli
Department of Anesthesiology, S. Salvatore Hospital, L'Aquila, Italy.
Donatella
D
Trovarelli
Department of Neurosurgery, S. Salvatore Hospital, L'Aquila, Italy.
Alessandro
A
Ricci
Department of University of L'Aquila, L'Aquila, Italy; Department of University of L'Aquila, L'Aquila, Italy.
Renato J
RJ
Galzio
Bipolar stimulator; electromyographic facial nerve monitoring; facial nerve; retrosigmoid approach; vestibular schwannomas
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