Intraoperative monitoring and facial nerve outcomes after vestibular schwannoma resection.

OBJECTIVE

To determine the predictive value of proximal facial nerve electrical threshold and proximal-to-distal facial muscle compound action potential amplitude ratio on facial nerve outcomes after resection of vestibular schwannomas.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary care hospital.

PATIENTS

Two hundred twenty-nine patients undergoing resection of vestibular schwannomas with intraoperative facial nerve monitoring at a single institution.

INTERVENTION

All patients underwent resection of vestibular schwannomas with the use of intraoperative monitoring.

MAIN OUTCOME MEASURE

Facial nerve function was classified according to the House-Brackmann scale at the patient's last office follow-up. Last follow-up was at least 6 months after surgery.

RESULTS

Good facial nerve function (House-Brackmann Grade I or II) was observed in 87% of the patients at their last office follow-up. Proximal-to-distal amplitude ratio and proximal electric threshold were statistically significant in predicting facial nerve outcome. A mathematical model predicting the probability of good outcome on the basis of the intraoperative parameters is presented.

CONCLUSION

Intraoperative monitoring has significantly decreased facial nerve morbidity in vestibular schwannoma surgery. Despite the advances in surgery and monitoring, a group of patients still have poor facial nerve outcomes. The use of intraoperative nerve monitoring may be able to predict poor long-term facial nerve outcomes and thus modify the timing of rehabilitation.