Facial and Cochlear Nerve Complications following Microsurgical Resection of Vestibular Schwannomas in a Series of 221 Cases

Source of support: Departmental sources Background: Despite improvements in microsurgical technique and the use of intraoperative electrophysiological monitor-ing, the potential for facial and cochlear nerve injury remains a possibility in the resection of vestibular schwan-nomas (VS). We reviewed a series of 221 cases of VS resected via a retrosigmoid approach at our institution from October 2008 to April 2014 and determined the incidence of postoperative facial and cochlear deficits. Material/Methods: A total of 221 patients – 105 (47.5%) male and 116 (52.5%) female – with a mean age of 46.1 years (range 29–73 years), with VS 3 cm (n=183, 82.8%) and <3 cm (n=38, 17.2%) underwent surgical resection via a ret-rosigmoid approach and were evaluated for postoperative facial and cochlear nerve deficits. Results: Near-total resection (>95 % removal) was achieved in 199 cases (90%) and subtotal resection (>90 % removal) in 22 cases (10%). At 6 month follow-up, House-Brackmann grades I–III were observed in 183 cases (82.8%), grade IV in 16 cases (7.2%), and grade V in 22 cases (10%). Of the 10 patients that had preoperative function-al hearing, 3 (33%) retained hearing postoperatively. Cerebrospinal fluid leakage occurred in 6 patients (2.7%), lower cranial nerve palsies in 9 patients (4.1%), and intracranial hematomas 3 cases (1.4%). Conclusions: The observed incidence of persistent postoperative nerve deficits is very low. Meticulous microsurgical dis-section of and around the facial and cochlear nerves with the aid of intraoperative electrophysiological nerv