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Otol Neurotol. 2013 Feb;34(2):304-10.

Improved facial nerve outcomes using an evolving treatment method for large acoustic neuromas.

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1
Michigan Ear Institute, 30055 Northwestern Highway, Farmington Hills, MI 48334, USA.

Abstract

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.

PMID:
23444478
[Indexed for MEDLINE]
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