Facial nerve sparing surgery for large vestibular schwannomas

Acta Neurochir (Wien). 2017 Jul;159(7):1213-1218. doi: 10.1007/s00701-017-3216-y. Epub 2017 May 22.


Background: Nowadays, there is a general trend in vestibular schwannoma (VS) surgery favoring near-total or subtotal tumor resection (NTR/STR) with facial nerve (FN) function preservation rather than gross total resection (GTR) with high risk of FN damage.

Methods: The surgical technique of FN sparing in large VS includes patient-tailored image-guided craniotomy, continuous intraoperative neurophysiological monitoring (INM), intracapsular wide tumor debulking, and only final extracapsular dissection with FN course identification and brainstem decompression. A small amount of residual tumor along the FN is accepted in order to not damage the nerve. Postoperative radiosurgery workup is then recommended.

Conclusions: NTR/STR resection with FN function sparing is a valid option for large VS.

Keywords: Cerebellopontine angle; Facial nerve; Intraoperative monitoring; Posterior fossa; Retrosigmoid approach; Vestibular schwannoma.

MeSH terms

  • Craniotomy / adverse effects
  • Craniotomy / methods*
  • Facial Nerve / surgery*
  • Facial Nerve Injuries / prevention & control
  • Humans
  • Intraoperative Neurophysiological Monitoring / methods
  • Neoplasm, Residual / surgery
  • Neuroma, Acoustic / surgery*
  • Postoperative Complications / prevention & control
  • Surgery, Computer-Assisted / adverse effects
  • Surgery, Computer-Assisted / methods*