Facial nerve function following middle fossa and translabyrinthine acoustic tumor surgery: a comparison

Postoperative facial function was compared for middle cranial fossa and translabyrinthine removal of acoustic tumors. Included were 164 primary acoustic tumor surgeries performed between 1988 and 1991 in patients with normal preoperative facial function; postoperative House-Brackmann facial function grade available immediately postoperatively, at time of discharge and at 1 year or more postoperatively; and a tumor 1.5 cm or smaller. There were 116 translabyrinthine surgeries and 48 middle fossa surgeries. There was no significant difference in facial function results between the two surgical approaches at any of the three postoperative time intervals. Immediate postoperative facial function grade I or II was present in 90 percent of patients who underwent the middle cranial fossa approach, and in 90 percent of those with translabyrinthine surgery. By long-term follow-up, grade I or II function was recorded after 96 percent of middle fossa, and 91 percent of translabyrinthine surgeries. Results were similar when evaluating subgroups of those with tumors measuring 1.0 or smaller and 1.1-1.5 cm. There was also no difference in facial function result between superior and inferior vestibular nerve tumors with either approach. The authors conclude that, in an experienced center, long-term postoperative facial function outcome is not a basis for selecting surgical approach for tumors measuring 1.5 cm or less.