Facial nerve outcomes in middle cranial fossa vs translabyrinthine approaches

OBJECTIVE: To compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size-matched vestibular schwannomas. STUDY DESIGN AND SETTING: Retrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty-four patients were identified meeting the above criteria, with sixty-three in the translabyrinthine group and sixty-one in the middle fossa group. One-week-postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm. RESULTS: The tumor size range for the MCF group was 3-18 mm while it was 4-18 min for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow-up. CONCLUSION: Facial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size. SIGNIFICANCE: Patients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach.