The best candidates for nerve-sparing stripping surgery for facial nerve schwannoma

Abstract

Objectives/Hypothesis: Clinical decision making for facial nerve schwannoma is particularly complicated in patients with good facial nerve function; however, an early nerve-sparing tumor resection stripping technique minimizes facial deficits associated with treatment. The present study characterized the optimal candidate for this nerve-sparing surgical strategy in patients with good facial function. Study Design: Retrospective study. Methods: Nerve-sparing stripping surgery was performed on 28 patients with facial nerve schwannoma. The House- Brackmann grading system was used to assess pre- and postoperative facial function. We retrospectively analyzed pre- and postoperative facial function, duration of facial palsy, tumor size, and location and number of involved segments. The data were analyzed using Fisher exact test and independent t tests. Results: Of the 28 patients, 18 successfully underwent stripping surgery and 16 had a favorable outcome. Favorable postoperative facial function was associated with good preoperative facial function (House-Brackmann grade [HBG] II); small, localized tumors; and tumors located in the geniculate ganglion and/or its proximal portion. Conclusions: Patients with facial nerve schwannoma who have good preoperative facial function (HBG 2), tumor located in the proximal portion of the geniculate ganglion, and small tumors (<2 cm) involving one or two facial nerve seg- ments can be the best candidates for nerve-sparing stripping surgery. Key Words: Facial nerve, schwannoma, facial palsy. Level of Evidence: 4