SURG-103. Functional preservation of facial nerve in large vestibular schwannomas: Strategies to optimise facial nerve outcomeIs total excision counter-productive?

Tumors of the cerebellopontine angle (CPA) pose a challenge to the neurosurgeon. As these tumors grow, distortion and compression of other nearby structures including the facial nerve and brainstem can occur resulting in cranial nerve dysfunction. Facial nerve paresis can be a devastating complication following resection of large cerebellopontine angle (CPA) tumors. Preoperative identification of the facial nerve could help prevent inadvertent injury to the nerve during dissection and removal of the tumor. The aim of modern vestibular schwannoma (VS) surgery is complete tumor removal as well as preservation of neurological functions and quality of life. Early identification of the facial nerve during surgery, based on its relation to anatomical landmarks and on the application of electrical stimulation and electromyographic monitoring, is among the main prerequisites for its preservation. In large VSs, however, the preservation of the facial nerve may be challenging. In this study, authors compare their results of Gross total resection versus near total resection for large vestibular schwannomas and comparing the facial nerve outcome. The relevant published literature is also reviewed for this topic. The authors conclude that near total excision may be better for facial nerve functional preservation.