Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment. Otolaryngol Head Neck Surg

France, by surgical excision. The findings over the last 7 years are presented. The translabyrinthine upproach has been used in more than 85 % of cases. Where hearing preservation is attempted, the middle fossu approach has been adopted for lntracanilicular tumors and the refmsigmoid uppmach for small tumors extending into the cerebellopontine angle, in which the fundus of the internal meatus is free of tumor. The main goal is to achieve a grade I or II result in facial function within 1 month of surgery. Results improved during 1991 after the introduction of continuous facial nerve monitoring and the use of the Beaver mini-blade for dissection of tumor from nerve. With these techniques, facial function at grade I or II at 1 month improved from 20 % to 52 % for large tumors (larger than 3 cm), from 42 % to 81 % for medium tumors (2 to 3 cm), and from 70% to 92 % for small tumors (up to and including 2 cm extracanalicular). The facial nerve was at greater risk using the retrosigmoid or middle fossa approaches than by the translabyrinthine route. Since 1985, success in hearing preservation has changed little, with useful hearing being preserved in 38.2 % of cases operated on by means of the retrosigmoid route and 36.4 % of cases after the middle fossa approach. In older patient