Facial Nerve Outcomes in Functional Vestibular Schwannoma Surgery: Less-than-Total Tumor Excision Significantly Improves Results

Objective: Since 2007, our department has taken a functional approach to vestibular schwannoma surgery, with facial nerve function prioritized higher than total tumor excision—this represents a change in philosophy away from pursuit of total tumor excision. The aim of this study is to evaluate the effects of this change in philosophy.

Design: Retrospective cohort study.

Materials, Methods, and Patients: The “functional” surgical group was treated after April 2007 (n = 54; mean cerebellopontine angle dimension, 28 mm). The “excisional” surgical group, which was matched for tumor size, was treated from 1997–April 2007 (n = 115).

Outcomes Measured: Facial nerve status, tumor recurrence in less-than-total tumor excision, and need for rehabilitative treatments.

Statistical Analysis: Chi-square test to compare good (HB I-II) and moderate to poor (HB III–VI).

Results: In the functional group, the proportion of patients treated with less-than-total tumor excision was 80% versus 23% in the total excisional group. Facial nerve preservation in the functional group was 80% for HB I–II (65% in HB I) and 0% in HB V–VI at 12 months. In the matched excisional group, facial nerve preservation was 57% for HB I–II and 15% for HB V–VI at 12 months (P = 0.004). For tumor recurrence, the results were as follows: total excision in 1%, near-total in 2%, and subtotal in 29%.

Conclusions: A functional approach to vestibular schwannoma surgery improves facial nerve preservation outcomes and reduces the requirement for facial nerve rehabilitative interventions. Tumor recurrence is low in near-totally excised lesions but significant if only subtotal excision is achieved.