Intracanalicular vestibular schwannomas: facial and hearing outcomes according to the location of the tumor in relation to the nerves of the internal auditory canal

Abstract

OBJECTIVE The objective was to evaluate whether the position of the nerves within the internal auditory canal (IAC) has any effect on preoperative and postoperative cochlear and facial nerve function in patients with intracanalicular vestibular schwannoma (VS) resected through the retrosigmoid transmeatal approach. METHODS Forty-four patients with sporadic intracanalicular VS, from a series of 710 patients with VS who underwent operations from January 1993 to April 2022, were retrospectively reviewed. The pattern of displacement of the cranial nerves and tumor within the IAC was recorded. Tumors were divided into 2 types: type T1A lesions had only anteriorly displaced nerves, and type T1B had posteriorly displaced vestibular nerves and anteriorly displaced facial and cochlear nerves. Differences in surgical outcomes between groups in terms of facial nerve function and hearing preservation were evaluated. RESULTS Thirty-five cases (79.5%) were T1A tumors and 9 were T1B (20.5%). Gross-total resection and anatomical preservation of the facial and cochlear nerves were achieved in all patients. Postoperatively, all patients with T1A VS maintained normal facial nerve function; however, among T1B VS patients, 6 (67%) retained House-Brackmann grade I, 2 worsened to grade II, and 1 worsened to grade III at 6 months (p = 0.006). The 27 T1A VS patients with serviceable hearing maintained this status, and an additional patient with nonserviceable hearing improved to serviceable hearing; among T1B VS patients, only 2 of the 5 patients with serviceable hearing remained as such, 2 evolved to nonserviceable hearing, and 1 lost hearing after surgery (p = 0.0022). T1B VS patients had a 24-fold risk of facial nerve deterioration (relative risk [RR] 25.2, 95% CI 1.42–448.57, p = 0.028) and a 32-fold risk of hearing deterioration (RR 32.7, 95% CI 1.93–553, p = 0.016) after surgery. CONCLUSIONS In intracanalicular VS, postoperative cochlear and facial nerve function are directly related to the location of the tumor in relation to the nerves, with worse outcomes in cases where the tumor is located between the vestibular and facial-cochlear nerves.