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Published on: March 1, 2015
Improved facial nerve outcomes using an evolving treatment method for large acoustic neuromas
Ryan G Porter1, Michael J LaRouere, Jack M Kartush
1Michigan Ear Institute, 30055 Northwestern Highway, Farmington Hills, MI 48334, USA.
Objective:
To describe a successful paradigm for the treatment of large acoustic neuromas (vestibular schwannomas).
Study Design:
Retrospective case review.
Setting:
Tertiary referral center.
Patients:
The charts of 2,875 acoustic neuroma patients at Michigan Ear Institute were reviewed to identify 153 patients who underwent surgical resection for large acoustic neuromas (>=3 cm) between 2000 and 2009.
Intervention(S):
Staged surgical resection or single stage surgery with or without adjuvant stereotactic radiosurgery.
Main Outcome Measure(S):
Postoperative facial nerve outcomes are reported using the House-Brackmann (HB) facial nerve grading scale and compared with historical controls from a literature review. Rates of adverse outcomes are also reported.
Results:
Seventy-five patients underwent staged surgical resection of their tumors, whereas 78 patients underwent either single stage surgery or surgery with subsequent stereotactic radiosurgery. Eighty-one percent of patients in the staged surgical resection group had a postoperative HB Grade I or II facial nerve function compared with 75% in the single stage surgical group. Overall, 78% of patients in the current study had HB Grade I or II after treatment compared with a mean of 53% in the literature for similar sized tumors. Our methods including the decision to use staged surgery when necessary, dissection of tumor with stimulating dissector-directed intraoperative monitoring, and use of adjuvant stereotactic radiosurgery are described.
Conclusion:
Using the described paradigm, large acoustic neuromas can be successfully treated with either staged or single-stage surgical resection with or without adjuvant radiosurgery to obtain more favorable facial nerve outcomes than historically reported controls while minimizing morbidity for the patient.
