TY - JOUR
T1 - Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma
AU - Bloch, Orin
AU - Sughrue, Michael E.
AU - Kaur, Rajwant
AU - Kane, Ari J.
AU - Rutkowski, Martin J.
AU - Kaur, Gurvinder
AU - Yang, Isaac
AU - Pitts, Lawrence H.
AU - Parsa, Andrew T.
N1 - Funding Information:
Acknowledgment Dr. Parsa is supported, in part, by the Reza and Georgianna Khatib endowed chair in skull base tumor surgery. Dr. Sughrue is supported by the Neurosurgery Research & Education Foundation grant from the American Association of Neurological Surgeons (AANS NREF). Mr. Rutkowski is supported by the Doris Duke foundation. Mr. Kane is supported by the Howard Hughes Medical Foundation and the Ivy Foundation. We would like to thank our neuro-otology Steven Cheung, M.D. and Lawrence Lustig, M.D. for their help performing these operations.
PY - 2011/4
Y1 - 2011/4
N2 - Avoidance of facial nerve palsy is one of the major goals of vestibular schwannoma (VS) microsurgery. In this study, we examined the significance of previously implicated prognostic factors (age, tumor size, the extent of resection and the surgical approach) on post-operative facial nerve function. We selected all VS patients from prospectively collected database (1984-2009) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. The effect of variables such as surgical approach, tumor size, patient age and extent of resection on rates facial nerve dysfunction after surgery, were analyzed using multivariate logistic regression. Patients with preoperative facial nerve dysfunction (House-Brackman [HB] score 3 or higher) were excluded, and HB grade of 1 or 2 at the last follow-up visit was defined as "facial nerve preservation." A total of 624 VS patients were included in this study. Multivariate logistic regression analysis found that only pre-operative tumor size significantly predicted poorer facial nerve outcome for patients followed-up for ≥6 and ≥12 months (OR 1.27, 95% CI 1.09-1.49, p < 0.01; OR 1.35, 95% CI 1.10-1.67, P < 0.01, respectively). We found no significant relationship between facial nerve function and age, extent of resection, surgical approach, or tumor size (when extent of resection and surgical approach were included in the regression analysis). Because facial nerve palsy is a debilitating and psychologically devastating condition for the patient, we suggest altering surgical aggressiveness in patients with unfavorable tumor anatomy, particularly in cases with large tumors where overaggressive resection might subject the patient to unwarranted risk. Residual disease can be followed and controlled with radiosurgery if interval growth is noted.
AB - Avoidance of facial nerve palsy is one of the major goals of vestibular schwannoma (VS) microsurgery. In this study, we examined the significance of previously implicated prognostic factors (age, tumor size, the extent of resection and the surgical approach) on post-operative facial nerve function. We selected all VS patients from prospectively collected database (1984-2009) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. The effect of variables such as surgical approach, tumor size, patient age and extent of resection on rates facial nerve dysfunction after surgery, were analyzed using multivariate logistic regression. Patients with preoperative facial nerve dysfunction (House-Brackman [HB] score 3 or higher) were excluded, and HB grade of 1 or 2 at the last follow-up visit was defined as "facial nerve preservation." A total of 624 VS patients were included in this study. Multivariate logistic regression analysis found that only pre-operative tumor size significantly predicted poorer facial nerve outcome for patients followed-up for ≥6 and ≥12 months (OR 1.27, 95% CI 1.09-1.49, p < 0.01; OR 1.35, 95% CI 1.10-1.67, P < 0.01, respectively). We found no significant relationship between facial nerve function and age, extent of resection, surgical approach, or tumor size (when extent of resection and surgical approach were included in the regression analysis). Because facial nerve palsy is a debilitating and psychologically devastating condition for the patient, we suggest altering surgical aggressiveness in patients with unfavorable tumor anatomy, particularly in cases with large tumors where overaggressive resection might subject the patient to unwarranted risk. Residual disease can be followed and controlled with radiosurgery if interval growth is noted.
KW - Acoustic neuroma
KW - Facial nerve function
KW - Facial nerve palsy
KW - Microsurgery
KW - Vestibular schwannoma
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U2 - 10.1007/s11060-010-0315-5
DO - 10.1007/s11060-010-0315-5
M3 - Article
C2 - 20694574
AN - SCOPUS:79953706869
SN - 0167-594X
VL - 102
SP - 281
EP - 286
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 2
ER -