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Bulent Mamikoglu, MD; Carlos R. Esquivel, MD; Richard J. Wiet, MD

Arch Otolaryngol Head Neck Surg. 2003;129:429-431.

Objective  To compare postoperative facial nerve function results according to surgical approach.

Study Design  Retrospective case review study.

Setting  All surgical procedures were conducted in collaboration with a neurosurgery team in teaching hospitals with an academic affiliation.

Patients  Patients with medium to large vestibular schwannomas, with the tumor size ranging from 2 to 3 cm. Ninety-eight patients were identified from an "Acoustic Neuroma Database" (date range of search, 1983-2000).

Main Outcome Measures  The House-Brackmann scale was used for grading facial function in the immediate postoperative period and 1 year after. Guidelines of the American Academy of Otolaryngology–Head and Neck Surgery were used for classification of hearing preservation.

Results  Of the 98 patients, 17 were operated on through a retrosigmoid approach and 81 through the translabyrinthine route. The mean ± SD ages of these 2 groups of patients were 46 ± 13 and 51 ± 14 years, respectively; mean ± SD tumor sizes were 2.5 ± 0.27 and 2.6 ± 0.28 cm, respectively. One year after tumor removal via retrosigmoid approach, 10 (59%) of the 17 patients had good (grade I-II) facial functions and 2 (12%) had poor (grade V-VI) function. In the translabyrinthine group, 54 (68%) of 79 patients (2 patients had subtotal total tumor removal) had good facial nerve function at the end of the 1-year follow-up, and 13 (17%) continued to have poor facial function. The difference between these groups was not statistically significant (P>.05). Hearing was preserved in 4 (24%) of the 17 patients in the retrosigmoid group.

Conclusion  Although the translabyrinthine approach may offer better long-term facial function compared with the retrosigmoid approach in patients with medium-sized tumors, the difference between these 2 groups was not significant enough to favor one approach over the other.

From the Division of Otolaryngology/Neurotology (Drs Mamikoglu, Esquivel, and Wiet) and Evanston Research Institute (Dr Mamikoglu), Evanston Northwestern Healthcare, Evanston, Ill. Dr Mamikoglu is now in private practice with Pocahontas Health Care Specialists, Pocahontas, Ark. Dr Esquivel is now with Madigan Army Medical Center, Tacoma, Wash. The authors have no relevant financial interest in this article.

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