The best candidates for nerve-sparing stripping surgery for facial nerve schwannoma.

OBJECTIVES/HYPOTHESIS: Clinical decision making for facial nerve schwannoma is particularly complicated in patients with good facial nerve function; however, an early nerve-sparing tumor resection stripping technique minimizes facial deficits associated with treatment. The present study characterized the optimal candidate for this nerve-sparing surgical strategy in patients with good facial function.

STUDY DESIGN: Retrospective study.

METHODS: Nerve-sparing stripping surgery was performed on 28 patients with facial nerve schwannoma. The House-Brackmann grading system was used to assess pre- and postoperative facial function. We retrospectively analyzed pre- and postoperative facial function, duration of facial palsy, tumor size, and location and number of involved segments. The data were analyzed using Fisher exact test and independent t tests.

RESULTS: Of the 28 patients, 18 successfully underwent stripping surgery and 16 had a favorable outcome. Favorable postoperative facial function was associated with good preoperative facial function (House-Brackmann grade [HBG] ≤II); small, localized tumors; and tumors located in the geniculate ganglion and/or its proximal portion.

CONCLUSIONS: Patients with facial nerve schwannoma who have good preoperative facial function (HBG ≤2), tumor located in the proximal portion of the geniculate ganglion, and small tumors (<2 cm) involving one or two facial nerve segments can be the best candidates for nerve-sparing stripping surgery.

LEVEL OF EVIDENCE: 4