Skull Base 2011; 21(2): 099-102
DOI: 10.1055/s-0030-1270211
ORIGINAL ARTICLE

© Thieme Medical Publishers

Fundus Obliteration and Facial Nerve Outcome in Vestibular Schwannoma Surgery

Vincent Van Rompaey1 , Joost van Dinther1 , Andrzej Zarowski1 , Erwin Offeciers1 , Thomas Somers1
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, St. Augustinus Hospital, Wilrijk, Antwerp, Belgium
Further Information

Publication History

Publication Date:
20 December 2010 (online)

ABSTRACT

The major objectives in vestibular schwannoma (VS) surgery have evolved from reducing mortality to functional preservation of the facial nerve and hearing. Absence of fluid between the lateral end of the VS and the internal auditory canal fundus on magnetic resonance imaging (MRI) appeared to have a negative influence on hearing outcome. Our goal was to study the prognostic significance of fundus obliteration on facial nerve function after VS surgery in patients with clinically normal facial function. We performed a retrospective review in a tertiary referral neurotology unit or 110 consecutive patients with a surgically removed VS and normal preoperative facial nerve function. Facial nerve function was evaluated at 1 month and 1 year by using the House-Brackmann (HB) scale and correlated to fundus obliteration on MRI. Facial nerve function was intact preoperatively in 114 of 123 patients (92.7%). We noticed a statistically significant difference and worse short-term outcome when the fundus was obliterated: 29.7% had HB 3 or more versus 13.0% if no fundus obliteration was seen. This statistically significant difference disappeared at 1 year. Fundus obliteration has a negative prognostic influence on short-term facial nerve function after VS surgery in patients with clinically normal facial function preoperatively.

REFERENCES

  • 1 Tos M, Stangerup S E, Cayé-Thomasen P, Tos T, Thomsen J. What is the real incidence of vestibular schwannoma?.  Arch Otolaryngol Head Neck Surg. 2004;  130 216-220
  • 2 Howitz M F, Johansen C, Tos M, Charabi S, Olsen J H. Incidence of vestibular schwannoma in Denmark, 1977-1995.  Am J Otol. 2000;  21 690-694
  • 3 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve—preservation and restitution of function.  Neurosurgery. 1997;  40 684-694 discussion 694-695
  • 4 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections.  Neurosurgery. 1997;  40 248-260 discussion 260-262
  • 5 Couloigner V, Gervaz E, Kalamarides M et al.. Clinical and histologic parameters correlated with facial nerve function after vestibular schwannoma surgery.  Skull Base. 2003;  13 13-19
  • 6 Fenton J E, Chin R Y, Fagan P A, Sterkers O, Sterkers J M. Predictive factors of long-term facial nerve function after vestibular schwannoma surgery.  Otol Neurotol. 2002;  23 388-392
  • 7 Fenton J E, Chin R Y, Fagan P A, Sterkers O, Sterkers J M. Facial nerve outcome in non-vestibular schwannoma tumour surgery.  Acta Otorhinolaryngol Belg. 2004;  58 103-107
  • 8 Somers T, Casselman J, de Ceulaer G, Govaerts P, Offeciers E. Prognostic value of magnetic resonance imaging findings in hearing preservation surgery for vestibular schwannoma.  Otol Neurotol. 2001;  22 87-94
  • 9 Kobayashi M, Tsunoda A, Komatsuzaki A, Yamada I. Distance from acoustic neuroma to fundus and a postoperative facial palsy.  Laryngoscope. 2002;  112 168-171
  • 10 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
  • 11 Casselman J W. Temporal bone imaging.  Neuroimaging Clin N Am. 1996;  6 265-289

Thomas SomersM.D. Ph.D. 

Skull Base Team, St. Augustinus Hospital

Oosterveldlaan 24, 2610 Wilrijk, Antwerp, Belgium

Email: thomas.somers@gza.be