Facial nerve outcomes in functional vestibular schwannoma surgery: less than total tumour excision significantly improves results.

Objectives:To determine the implications of a functional approach to vestibular schwannoma surgery, with facial nerve function prioritised higher than total tumour excision.Study design:A case-control study in a tertiary referral neurotology clinic.Patients:A 'functional' surgical group treated after April 2007 (n = 44, mean cerebellopontine angle dimension 27 mm), and an 'excisional' surgical group matched for tumour size, treated from 1997 to April 2007 (n = 115).Intervention:Change to more functional surgical approach.Main outcomes measured:Primary outcome: facial nerve status. Secondary outcome: tumour recurrence in less-than-total tumour excision.Results:Facial nerve preservation: 77 per cent House-Brackmann grade I-II in functional group at 12 months, versus 57 per cent grade I-II in excisional group (p = 0.027). Tumour recurrence: 1 per cent in total excision group, 2 per cent in near-total group and 40 per cent in sub-total group.Conclusion:A functional approach to vestibular schwannoma surgery improves facial nerve preservation outcomes and reduces the requirement for facial nerve rehabilitative interventions. Tumour recurrence rates are low in near-totally excised lesions but significant if only sub-total excision is achieved.