Advantages of Facial Nerve Rerouting in Extended Modified Translabyrinthine Approach

Objectives: Facial nerve dissection in T4 acoustic neuroma remained a difficult task. The most vulnerable part of FN on the tumors was an edge of internal auditory canal and anterior part of the tumor. The facial nerve was an anterior limitation in TL approach. Authors analyzed impact of facial nerve rerouting as an modification of ExTL approach allowing for better controlling of FN course.

Material and Method: Retrospective studies were performed in ENT university department based on data of patients with ANs in stage IV, Koos Perneczky, classification. There were two groups—first group consisted of 17 patients operated by ExTL without rerouting of the FN (av. AP – diameter: 41 mm). Second group consisted of 13 patients with AN operated by ExTL approach with FN rerouting (av. AP diameter: 38 mm).

Results: FN—anatomical preservation were obtained in a group with FN rerouting in 84% and respectively in 82% in pts with no rerouting of FN. Early FN function - Stage 1–3 HB were accounted in a group with rerouting of FN in 5 out of 12 cases, and respectively in 4 out of 17 cases in a group with no rerouting of FN. No important neurological complications were stated in both groups. Average time of operation in cases with rerouting of FN was shorter.

Conclusion: Rerouting of the facial nerve allow to better view for removing of the pyramids toward apex and posteriorly from cerebellum. This approach can be an alternative to transcochlear one. Rerouting does not lower the functional results of FN function and create better condition for FN preservation.