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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Preservation of the facial nerve following surgical removal of vestibular schwannomas after failed radiosurgery

Meeting Abstract

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  • Marcos Tatagiba - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen, Germany
  • Florian Ebner - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1729

DOI: 10.3205/10dgnc200, URN: urn:nbn:de:0183-10dgnc2007

Published: September 16, 2010

© 2010 Tatagiba et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Aim of this retrospective study was to show the results of the facial nerve following vestibular schwannoma surgery after failed radiosurgery. Radiosurgery has been increasingly used as an alternative treatement for VS. Currently there is a controversial discussion whether previous radiation may lead to more difficult surgery of VS and thereby increase the risk for the facial nerve.

Methods: In a series of 250 surgical cases of VS, a total of 9 patients, who had received previous radiosurgery were investigated. All 9 patients presented with growing tumors at MRI investigations. Surgical and clinical records were studied, and follow-up investigations were performed.

Results: In the total series of 250 VS, complete tumor resection was achieved in over 95%, and facial nerve function was preserved in 98% of the cases. Among the 9 patients with previous radiosurgery, four patients had incomplete tumor removal. Postoperative facial function was classified acording to House and Brakmann method as follows: Grade I and II (good facial function), 4 patients, Grade III (significant palsy), 3 patients, Grade V (severe palsy) 2 patients. There was no mortality in this series.

Conclusions: Tumor removal after radiosurgery will not necessarily result in facial palsy. However, there is an increased risk of injuring the facial nerve during tumor dissection, due to the increased tumor tissue consistency, the increased adherence between tumor surface and nerves, and due to the lack of a soft arachnoidal plane. In addition, an irradiated facial nerve's regeneration potential seems to be diminished. We recommend that patients, who require microsurgical excision following radiosurgery have a more conservative approach compared to non-irradiated cases.