Microsurgical Treatment Of Large Acoustic Neuromas

Objective To evaluate the microsurgical technique and functional facial nerve preservation in microsurgical removal of large acoustic neuromas.Methods Form January2009to December2011,45patients with larger acoustic neuromas (diameter≥3cm) were managed microsurgical methods in the two wards of neurosurgery department in the Fist Affiliated Hospital of GuangXi Medical University,whose clinical manifestations,preoperative CT and MRI features, the operative report,Glasgow Outcome Scale(GOS) and facial nerve function at discharge were analyzed retrospectivelyResults Total removal was achieved in41patients (91%) and subtotal in4patients(9%). The facial nerve was anatomically preserved in39(86.7%) of the patients. First postoperative day, computed tomography(CT) of the brain revealed there are a small amount of bleeding in local operation area in15cases, hematoma are removed by craniotomy in three cases. Eight patients developed postoperative meningitis but recovered uneventfully with conservative treatment. Five cases whose preoperative hydrocephalus was not improved after operation were managed by ventriculo-peritoneal shunting. Cerebrospinal fluid leak occurred in4(8.8%) patients, but there were only one case required second procedure on CSF leakage repair. There was one case of postoperative death relating with hematoma, lower cranial nerve paresis, and infection in pneumopathy. The function of the facial nerve evaluated with House-Brackmann at discharge were following:H-B Grade Ⅰ-Ⅱ in13(30%), Grade Ⅲ-Ⅳ in30(68%), GradeⅤ-Ⅵ in1(2%). The Glasgow Outcome Scale is5(good recovery) in40cases (89%);4(mild disability, life can take care of themselves) in3cases (7%),3points (severe disability, daily life in need of care) in1cases(2%), and1point (death) in1patient (2%).Conclusion:Microsugical surgery is an effective method of treatment of large acoustic neuromas. Undergoing suboccipital retrosigmoid approach one can succeed to get high rate of total acoustic neuromas removal and facial nerve preservation. Skilled knowledge of the microsurgical anatomy and skilled microsurgical techniques is the key to successful operation.