Patient-reported outcomes are increasingly used in studies of vestibular schwannoma (VS); however, few studies have examined self-evaluated facial nerve function and its relation to physician-reported outcomes. The primary objective of this study was to compare patient self-evaluations of facial disability with physician-evaluated facial nerve status and with self-evaluations of a healthy control group. The second objective was to provide insight into the controversial subject of the optimal initial management of small- and medium-sized VSs; consequently, the authors compared patient-reported facial nerve disability following treatment via observation (OBS), Gamma Knife surgery (GKS), or microsurgery (MS). Lastly, the authors sought to identify risk factors for facial nerve dysfunction following treatment for small- and medium-sized VSs.
All patients with a VS 3 cm or smaller that was singly treated with OBS, GKS, or MS at either of 2 independent treatment centers between 1998 and 2008 were retrospectively identified. Longitudinal facial nerve measures and clinical data, including facial nerve evaluation according to the House-Brackmann (HB) grading system, were extracted from existing VS databases. Supplementing the objective data were Facial Disability Index (FDI) scores, which were obtained via survey of patients a mean of 7.7 years after initial treatment.
The response rate among the 682 eligible patients was 79%; thus, data from a total of 539 patients were analyzed. One hundred forty-eight patients had been managed by OBS, 247 with GKS, and 144 with MS. Patients who underwent microsurgery had larger tumors and were younger than those who underwent OBS or GKS. Overall, facial nerve outcomes were satisfactory following treatment, with more than 90% of patients having HB Grade I function at the last clinical follow-up. Treatment was the major risk factor for facial nerve dysfunction. Almost one-fifth of the patients treated with MS had an objective decline in facial nerve function, whereas only 2% in the GKS group and 0% in the OBS cohort had a decline. The physical subscale of the FDI in the VS patients was highly associated with HB grade; however, the social/well-being subscale of the FDI was not. Thus, any social disability caused by facial palsy was not detectable by use of this questionnaire.
The majority of patients with small- and medium-sized VSs attain excellent long-term facial nerve function and low facial nerve disability regardless of treatment modality. Tumor size and microsurgical treatment are risk factors for facial nerve dysfunction and self-reported disability. The FDI questionnaire is sensitive to the physical but not the social impairment associated with facial dysfunction.
ABBREVIATIONSAAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; FDI = Facial Disability Index; GKS = Gamma Knife surgery; HB = House-Brackmann; MS = microsurgery; OBS = observation; QOL = quality of life; VS = vestibular schwannoma.
American Academy of Otolaryngology–Head and Neck Surgery: Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg113:179–1801995
American Academy of Otolaryngology–Head and Neck Surgery: Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). 113:179–180, 1995767547510.1016/S0194-5998(95)70101-X)| false
AndersonDELeonettiJWindJJCribariDFaheyK: Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome. J Neurosurg102:643–6492005
AndersonDE, LeonettiJ, WindJJ, CribariD, FaheyK: Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome. 102:643–649, 20051587150610.3171/jns.2005.102.4.0643)| false
BlochO, SughrueME, KaurR, KaneAJ, RutkowskiMJ, KaurG, : Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma. 102:281–286, 201110.1007/s11060-010-0315-520694574)| false
CharpiotATringaliSZaoucheSFerber-ViartCDubreuilC: Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: Outcomes for 123 patients. Acta Otolaryngol130:1249–12552010
CharpiotA, TringaliS, ZaoucheS, Ferber-ViartC, DubreuilC: Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: Outcomes for 123 patients. 130:1249–1255, 201010.3109/0001648100376231620443757)| false
JacobARobinsonLLJrBortmanJSYuLDodsonEEWellingDB: Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center. Laryngoscope117:2087–20922007
LanmanTH, BrackmannDE, HitselbergerWE, SubinB: Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. 90:617–623, 19991019360410.3171/jns.1999.90.4.0617)| false
ManiakasA, SalibaI: Microsurgery versus stereotactic radiation for small vestibular schwannomas: a meta-analysis of patients with more than 5 years' follow-up. 33:1611–1620, 201210.1097/MAO.0b013e31826dbd0222996165)| false
MartinHC, SethiJ, LangD, Neil-DwyerG, LutmanME, YardleyL: Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. 94:211–216, 200110.3171/jns.2001.94.2.021111213956)| false
MartinTPTzifaKKowalskiCHolderRLWalshRIrvingRM: Conservative versus primary surgical treatment of acoustic neuromas: a comparison of rates of facial nerve and hearing preservation. Clin Otolaryngol33:228–2352008
MartinTP, TzifaK, KowalskiC, HolderRL, WalshR, IrvingRM: Conservative versus primary surgical treatment of acoustic neuromas: a comparison of rates of facial nerve and hearing preservation. 33:228–235, 200810.1111/j.1749-4486.2008.01715.x18559028)| false
MilliganBD, PollockBE, FooteRL, LinkMJ: Long-term tumor control and cranial nerve outcomes following Gamma Knife knife surgery for larger-volume vestibular schwannomas. 116:598–604, 20122217572410.3171/2011.11.JNS11811)| false
MyrsethEMøllerPPedersenPHVassbotnFSWentzel-LarsenTLund-JohansenM: Vestibular schwannomas: clinical results and quality of life after microsurgery or Gamma Knife radiosurgery. Neurosurgery56:927–9352005
MyrsethE, MøllerP, PedersenPH, VassbotnFS, Wentzel-LarsenT, Lund-JohansenM: Vestibular schwannomas: clinical results and quality of life after microsurgery or Gamma Knife radiosurgery. 56:927–935, 200515854240)| false
NonakaYFukushimaTWatanabeKFriedmanAHSampsonJHMcElveenJTJr: Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade.. Neurosurgery72:2 Suppl Operativeons103–ons1152013
NonakaY, FukushimaT, WatanabeK, FriedmanAH, SampsonJH, McElveenJTJr, : Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade.. 72:2 Suppl Operativeons103–ons115, 2013)| false
NoudelRGomisPDuntzeJMarnetDBazinARochePH: Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and retrosigmoid approaches. Acta Neurochir (Wien)151:935–9452009
NoudelR, GomisP, DuntzeJ, MarnetD, BazinA, RochePH: Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and retrosigmoid approaches. 151:935–945, 20091941517310.1007/s00701-009-0344-z)| false
PollockBEDriscollCLFooteRLLinkMJGormanDABauchCD: Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery59:77–852006
SamiiM, MatthiesC: Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve—preservation and restitution of function. 40:684–695, 1997909284110.1097/00006123-199704000-00006)| false
ShafferBT, CohenMS, BigelowDC, RuckensteinMJ: Validation of a disease-specific quality-of-life instrument for acoustic neuroma: the Penn Acoustic Neuroma Quality-of-Life Scale. 120:1646–1654, 20102064108510.1002/lary.20988)| false
Van SwearingenJM, BrachJS: The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. 76:1288–1300, 199610.1093/ptj/76.12.1288)| false
ZygourakisCCOhTSunMZBaraniIKahnJGParsaAT: Surgery is cost-effective treatment for young patients with vestibular schwannomas: decision tree modeling of surgery, radiation, and observation. Neurosurg Focus37:5E82014
ZygourakisCC, OhT, SunMZ, BaraniI, KahnJG, ParsaAT: Surgery is cost-effective treatment for young patients with vestibular schwannomas: decision tree modeling of surgery, radiation, and observation. 37:5E8, 20142621862110.3171/2014.8.FOCUS14435)| false