Facial nerve repair techniques in cerebellopontine angle tumor surgery

This study reviewed the technique and outcome of facial nerve repair in cases of cerebellopontine angle (CPA) tumor that resulted in transection of the facial nerve. Between January 1982 and December 1989, the facial nerve was preserved in over 97.7 percent of 1110 cases of CPA tumor resection. Facial nerve repair was performed in 23 patients. The nerve repair was accomplished with either suture anastomosis or support with microfibrillar collagen. In the cases repaired with sutures, reanastomosis to a proximal facial nerve stump at the brain stem was performed with a single suture, while stabilizing the nerve with a fenestrated suction. Direct facial nerve neurorrhaphy or anastomosis with a greater auricular nerve interposition graft was successful in restoring tone and some degree of voluntary motion in 18 of the 21 patients with follow-up available (86%) and acceptable function (grade IV/VI or better) in 12 of 21 (57%). The degree of recovery of facial function was significantly better in patients without preoperative facial nerve symptoms and patients in whom the tumor did not arise from the facial nerve itself. We conclude that in cases of facial nerve transection in the CPA, good results are obtained by immediately reestablishing anatomic continuity of the nerve with direct reanastomosis or with a greater auricular nerve graft.