Who is the Best Candidate for Stripping Technique in the Facial Nerve Schwannoma?

Objectives: Although clinical decision-making is complicated in the facial nerve schwannomas with good facial function, early nerve-sparing tumor resection, stripping technique, has been designed to minimize facial deficits associated with facial nerve schwannomas with good facial function. This report aimed to determine optimal candidate of this revised surgical strategy in patients with good facial function by analysis of treatment outcome and to figure out the prognostic factors for the early intervention.

Study Design: Retrospective study.

Methods: We have tried a nerve-preserving stripping surgery on 28 patients with facial nerve schwannomas. The House-Brackmann grading(HBG) system was used to assess pre- and postoperative facial functions. We retrospectively investigated the following patient’s data for analysis: pre- and postoperative facial functions, duration of facial palsy, tumor size, location and number of involved segment. Fisher’s exact test and independent t-test was used for statistical analysis.

Results: Of the 28 patients 18 patients successfully underwent stripping surgery. Favorable recovery was only observed in 16 patients who underwent stripping surgery. Favorable facial function after nerve sparing stripping surgery were shown to the patients who had good preoperative facial function(HBG ≤II), small sized localized tumor and tumor located at geniculate ganglion and/or it’s proximal portion.

Conclusion: Facial nerve-preserving technique can be recommended to the facial nerve schwannoma patients who has preoperatively good facial function(HBG≤2), tumor located at geniculate ganglion and/or its proximal portion and localized, less than two segment involved, small sized tumor can be the good candidate for stripping surgery.