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Improving facial nerve outcome and hearing preservation by different degrees of vestibular schwannoma resection guided by intraoperative facial nerve electromyography

  • Original Article - Tumor - Schwannoma
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Abstract

Background

Facial nerve (FN) outcome has been improved by deciding upon the degree of vestibular schwannoma (VS) resection guided by intraoperative facial nerve monitoring (IOFM). This study aimed to evaluate hearing and FN outcomes following IOFM-guided VS removal through a retrosigmoid approach (RS).

Methods

Between January 2015 and August 2017, 77 patients undergoing VS resection through RS, regardless of their preoperative hearing or tumor size, were included in this monocentric retrospective study. Total or near-/subtotal resection was decided intraoperatively according to IOFM. Partial resection was planned preoperatively. Pre- and postoperative FN function (House-Brackmann) and hearing level (AAO-HNS and Gardner-Robertson (GR) scales) were reported. Predictive factors for hearing preservation were analyzed according to a score developed to take into account pre-/postoperative hearing evolution.

Results

The mean extrameatal diameter was 17 ± 8.5 mm. VS resection was total, near-/subtotal, and partial in 71%, 21%, and 8% of cases, respectively. Postoperative grade I and II FN function was achieved in 91% of patients. Serviceable (A+B or GR I+II) hearing and hearing with intelligibility (A+B+C or GR I–III) were preserved in 30% and 43% of cases, respectively. In multivariate analysis, preoperative synchronized auditory brainstem responses (ABR) were the only predictive factor (p = 0.006) imparting a five times greater chance of hearing preservation.

Conclusion

IOFM-guided VS excision through RS, whatever the VS size and hearing level, achieved a high rate of good postoperative FN function together with significant hearing preservation, and it should be used if hearing with some intelligibility is still present preoperatively, even in large VS.

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Author notes

  1. Hannah Daoudi and Ghizlene Lahlou contributed equally to this work.

Authors and Affiliations

  1. Sorbonne Université, Groupe Hospitalo-Universitaire Pitié-salpêtrière, Paris, France

    Hannah Daoudi, Ghizlene Lahlou, Vincent Degos, Olivier Sterkers, Yann Nguyen & Michel Kalamarides

  2. Department of Otolaryngology, GHU Pitié-salpétrière, Paris, France

    Hannah Daoudi, Ghizlene Lahlou, Olivier Sterkers & Yann Nguyen

  3. Department of Anesthesiology and Reanimation, GHU Pitié-salpétrière, Paris, France

    Vincent Degos

  4. Department of Neurosurgery, GHU Pitié-salpétrière, Paris, France

    Michel Kalamarides

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  1. Hannah Daoudi
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Correspondence to Ghizlene Lahlou.

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All of the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Portions of this work were presented as an oral communication at the 8th Quadrennial International Conference on Vestibular Schwannoma and Other CPA Tumors, Mayo Civic Center, Rochester, Minnesota, June 20, 2019.

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Daoudi, H., Lahlou, G., Degos, V. et al. Improving facial nerve outcome and hearing preservation by different degrees of vestibular schwannoma resection guided by intraoperative facial nerve electromyography. Acta Neurochir 162, 1983–1993 (2020). https://doi.org/10.1007/s00701-020-04397-4

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