Acoustic neurinoma surgery; can facial nerve be saved?

ABSTRACT

In a prospective study at Lahore general and Nishter hospital Multan thirty five cases of acoustic neurinoma were treated over 5 years. Duration of symptoms was between 3 months to 2 years. At presentation 20 patients had involvement of facial nerve. This involvement was of lower motor neurone type. Radiological investigations performed were CT scan in 29 cases and MR in 6 cases. Twenty five patients had Tumour bigger than 5 cm. There was no patient with tumour smaller than 3 cm. The cases were operated upon in parkbench position. Retrosigmoid subocciptal craniectomy was done and tumour was dissected under magnification by operative microscope. Preoperatively it was not possible to identify the nerve in 20 and it was anatomically preserved but deformed [flattened and very flimsy] in 14 patients and normal looking facial nerve was seen in 1 patient only. Postoperatively there was complete nerve deficit which did not improve after 4 years of follow-up