Author(s)
Daniel E. Killeen, MD
Samuel L. Barnett, MD
Bruce E. Mickey, MD
Jacob B. Hunter, MD
Brandon Isaacson, MD
J. Walter Kutz, Jr., MD
Affiliation(s)
Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
Abstract:
Objective: To explore the relationship between tumor size and facial nerve outcomes following vestibular
schwannoma (VS) resection.
Study Design: Single institutional retrospective chart review.
Setting: Tertiary referral center.
Patients: All adult patients with sporadic VS who underwent surgical resection from 2008 to 2018 with pre-operative
magnetic resonance imaging (MRI) and 10 months of post-surgical follow-up.
Interventions: VS resection
Main Outcome Measures: Facial nerve outcome as assessed by post-operative House-Brackmann score.
Results: One hundred seventy-five patients, 54.9% female, with a median age of 50 years (21 - 74 years), were identified
who underwent VS resection. Surgical resection was performed via translabyrinthine (76%), middle cranial fossa (13.7%),
retrosigmoid (8%), and transpromontorial (2.3%) approaches. The median tumor diameter and volume were 24.6 mm (4.1
- 47.1 mm) and 3.17 cm3 (0.01 - 30.6 cm3), respectively. The median follow-up was 23.7 months (10 - 114.2 months).
Gross total resection was performed in 77.1% of cases, with residual tumor identified on MRI in 17.9% of cases. For patients
with tumors <3 cm3, 91.9% had grade 1 or 2 facial function after at least 10 months follow-up, compared to 80.9% for those
with tumors >3 cm3 (univariate logistic regression OR=2.7, p=0.04). Increased tumor diameter was significantly associated
with facial weakness on univariate analysis but not multivariate analysis. Tumor volume >3 cm3 was predictive of facial
weakness on multivariate regression analysis (OR=4.0, p=0.041) when controlling for surgical approach, age, gender, and
extent of resection.
Conclusions: Tumor volume >3 cm3 is associated with poorer facial nerve outcomes 10 months following surgical
resection.
Define Professional Practice Gap & Educational Need: Knowledge of factors influencing facial nerve outcomes after
vestibular schwannoma resection
Learning Objective: Gain knowledge of predictive factors in facial nerve outcomes following vestibular schwannoma
resection
Desired Result: Improve patient counseling and inform patient decisions regarding optimal treatment of vestibular
schwannoma
Level of Evidence - V:
Indicate IRB or IACUC : University of Texas Southwestern Medical Center IRB STU 112016-040 - approved on
8/28/2019