Preoperative Radiological Features Predict Facial and Cochlear Nerve Function after Vestibular Schwannoma Surgery: A...

Vestibular schwannoma surgery carries risks of facial nerve (FN) dysfunction and hearing loss. This study aimed to identify preoperative radiological predictors of postoperative FN function and develop a predictive nomogram.

We retrospectively analyzed 262 patients who underwent retrosigmoid vestibular schwannoma resection at a single institution (December 2017-December 2025). The dataset was divided into training (n = 185) and validation (n = 77) sets. Univariate and multivariate logistic regression identified independent predictors of poor FN function (House-Brackmann grade ≥III), and a nomogram was constructed. Hearing outcomes were explored in 81 patients with preoperative serviceable hearing.

Multivariate analysis identified tumor laterality (odds ratio [OR = 2.69, P = 0.027), maximum tumor diameter (OR = 1.07, P = 0.002), fundal fluid cap sign (OR = 0.35, P = 0.020), and cerebrospinal fluid cleft sign (OR = 0.31, P = 0.009) as independent predictors of postoperative FN dysfunction. The nomogram demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.834 (95% confidence interval: 0.753-0.906) in the training set and 0.880 (95% confidence interval: 0.772-0.965) in the validation set. Calibration and decision curve analyses confirmed clinical applicability. For hearing outcomes, tumor diameter (OR = 1.11, P = 0.007) and brainstem compression (OR = 4.50, P = 0.020) were associated with postoperative hearing loss.

In this single-center cohort, tumor laterality, maximum diameter, fundal fluid cap sign, and cerebrospinal fluid cleft sign independently predicted postoperative FN function; the nomogram demonstrated satisfactory discrimination and calibration. These findings have refined our surgical approach for left-sided tumors and cleft-absent cases, pending multicenter validation.