• YuHai Zhang, YiJun Chen, YuanJie Zou, WenBin Zhang, Rui Zhang, Xiang Liu, Zhuhai Lv, Kun Yang, Xinhua Hu, ChaoYong Xiao, Wen Liu, and HongYi Liu.
• Department of Neurosurgery, Nanjing Medical University, Nanjing Brain Hospital, Nanjing, 210029, Jiangsu, China.
• Acta Neurochir (Wien). 2013 Oct 1;155(10):1857-62.

BackgroundMicrosurgery is an option of choice for large vestibular schwannomas (VSs). Anatomical and functional preservation of facial nerve (FN) is still a challenge in these surgeries. FNs are often displaced and morphologically changed by large VSs. Preoperative identification of FN with magnetic resonance (MR) diffusion tensor tracking (DTT) and intraoperative identification with facial electromyography (EMG) may be desirable for improving functional results of FN.MethodIn this retrospective study, eight consecutive cases with large VS (≥30 mm in maximal extrameatal diameter) were retrospectively studied. FN DTT was performed in each case preoperatively. All the cases underwent microsurgical resection of the tumor with intraoperative FN EMG monitoring. Correctness of prediction for FN location by DTT was verified by the surgeon's inspection. Postoperative FN function of each patient was followed up.ResultsPreoperative identification of FN was possible in 7 of 8 (87.5 %) cases. FN location predicted by preoperative DTT agreed to surgical finding in all the 7 cases. FN EMG was helpful to locate and protect the FN. Total resection was achieved in 7 of 8 (87.5 %). All FNs were anatomically preserved. All cases had excellent facial nerve function (House-Brackmann Grade I-II).ConclusionsFN DTT is a powerful technique in preoperatively identification of FN in large VS cases. Continuous intraoperative FN EMG monitoring is contributive to locating and protecting FNs. Radical resection of large VSs as well as favorable postoperative FN outcome is available with application of these techniques.

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