Facial nerve preservation in microsurgery for large acoustic neuroma: report of 38 cases

objective To summarize the experience with microsurgical techniques and electrophysiological monitoring in patients with large acoustic neuroma. Methods Clinical data of 38 patients with large acoustic neuroma were retrospectively analyzed. Facial nerve function was assessed by House-Brackmann (H-B) scale before the operation: class Ⅰ-Ⅱ in 36 cases and class Ⅲ-Ⅳ in 2. Results Total tumor resection was achieved in 33 cases, subtotal resection in 5, and preservation of facial nerve in 32. One patient died, and other patients were assessed by H-B scale at discharge: class Ⅰ-Ⅱ in 28 cases, class Ⅲ-Ⅳ in 6 and class Ⅴ-Ⅵ in 3. Conclusion The micro-surgical and electrophysiological monitoring technologies could obviously improve the operative effects. The key point of facial nerve preservation was to keep the integrity of arachnoid on the tumor surface. Reconstruction of the ruptured facial nerve might be helpful to recover the neurofunction.