• Esther X Vivas, Matthew L Carlson, Brian A Neff, Neil T Shepard, D Jay McCracken, Alex D Sweeney, and Jeffrey J Olson.
• Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
• Neurosurgery. 2018 Feb 1; 82 (2): E44-E46.

Question 1Does intraoperative facial nerve monitoring during vestibular schwannoma surgery lead to better long-term facial nerve function?Target PopulationThis recommendation applies to adult patients undergoing vestibular schwannoma surgery regardless of tumor characteristics.RecommendationLevel 3: It is recommended that intraoperative facial nerve monitoring be routinely utilized during vestibular schwannoma surgery to improve long-term facial nerve function.Question 2Can intraoperative facial nerve monitoring be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery?Target PopulationThis recommendation applies to adult patients undergoing vestibular schwannoma surgery.RecommendationLevel 3: Intraoperative facial nerve can be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery. Specifically, the presence of favorable testing reliably portends a good long-term facial nerve outcome. However, the absence of favorable testing in the setting of an anatomically intact facial nerve does not reliably predict poor long-term function and therefore cannot be used to direct decision-making regarding the need for early reinnervation procedures.Question 3Does an anatomically intact facial nerve with poor electromyogram (EMG) electrical responses during intraoperative testing reliably predict poor long-term facial nerve function?Target PopulationThis recommendation applies to adult patients undergoing vestibular schwannoma surgery.RecommendationLevel 3: Poor intraoperative EMG electrical response of the facial nerve should not be used as a reliable predictor of poor long-term facial nerve function.Question 4Should intraoperative eighth cranial nerve monitoring be used during vestibular schwannoma surgery?Target PopulationThis recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm.RecommendationLevel 3: Intraoperative eighth cranial nerve monitoring should be used during vestibular schwannoma surgery when hearing preservation is attempted.Question 5Is direct monitoring of the eighth cranial nerve superior to the use of far-field auditory brain stem responses?Target PopulationThis recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm.RecommendationLevel 3: There is insufficient evidence to make a definitive recommendation.  The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_4.Copyright © 2017 by the Congress of Neurological Surgeons

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