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Factors predicng facial nerve function after acoustic neuroma surgery
Author(s): ,
Y. Ceccaroni
Affiliations:
AOUI Verona, Neurosurgery, Verona, Italy
,
C. Pasquali
Affiliations:
AOUI Verona, Neurosurgery, Verona, Italy
,
F. Sala
Affiliations:
AOUI Verona, Neurosurgery, Verona, Italy
,
G. Pinna
Affiliations:
AOUI Verona, Neurosurgery, Verona, Italy
B. Masotto
Affiliations:
AOUI Verona, Neurosurgery, Verona, Italy
EANS Academy. Ceccaroni Y. Oct 21, 2018; 225959; EP4114
Dr. Yuri Ceccaroni
Dr. Yuri Ceccaroni
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Abstract
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Rationale. The preservation of facial nerve function is mandatory in vestibular schwannoma surgery in modern days. With this work we want to critically review what parameters may be important for the prediction of this outcome, in a homogeneous and large series of patients.

Materials and methods. We analyzed a series of 53 patients consecutively operated for Vestibular Schwannoma in the Neurosurgery Department of Verona in 2017. All the patients were operated by the senior surgeon via a retrosigmoid approach in the semisitting position. We analyzed the clinical and neuroradiological data, alongside the operative reports. We collected information concerning facial nerve function before and after surgery (HB grade immediately and at follow up), and we considered many parameters possibly involved in facial nerve outcome: age, tumor dimension, involvement of IAC, solid or cystic appearance, degree of resection. We also considered data concerning the intraoperative neurophysiologic monitoring (MEPs, EMG), used in every surgery.

Results. We collected 53 patients, mean age 48,8 (21-75 years). Preservation of a satisfactory facial nerve function (HB 1-2) was obtained in 32 pts (63,4%); we found a significative negative relation with tumor dimension, IAC involvement, and degree of resection, but not with age and tumor appearance. A drop in facial nerve MEPs and the presence of prolonged trains at the EMG also significantly related with a worse functional result. At the FU, we found an improvement in HB degree in 13 pts out of 21 (61,9%), in patients with stability of the IONM.

Discussion. With this work we confirmed the importance of many classical parameters for the preservation of facial nerve function; interestingly, an important parameter to acknowledge is the involvement of IAC, and not age nor cystic appearance. We confirmed also the fundamental relation between IONM data and postoperative nerve function, especially in the long term.
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