2026 Poster Presentations
P523: FACIAL NERVE FUNCTION POST VESTIBULAR SCHWANNOMA MICROSURGERY - A CASE SERIES OF 34-YEARS' EXPERIENCE
Bartlomiej Roj, MBBS1; Ebrar Gultekin, MD2; Cristina Cernei, BSc, Hons, MBBS, MRCS1; Camille Milton, BS, MD3; Will Singleton, MBBS1; Sean Himel, MBBS1; Owain Davies, MBBS1; Vignesh Veerappan, BSc, MBBS1; Liang-Fong Wong, MBBS1; Michael Poon, BSc, MBBS, PhD, MRCS1; Philip Clamp, BMBCh, MA, DOHNS, FRCS, ORLHNS4; Richard Nelson, MA, MBBS, FRCSEng, FRCSEd1; David Baldwin, MBBS1; Mario Teo, MBChBHons, BMedSciHons, PhD, FRCSSN1; 1Department of Neurosurgery, Southmead Hospital, Bristol, BS10 5NB; 2Department of Undergraduate Medicine, TOBB ETÜ, Ankara, Turkey; 3Department of Neurosurgery, University of Tennessee Health Science Center, TN, USA; 4Department of ENT, Southmead Hospital, Bristol, BS10 5NB
Introduction: The extent of vestibular schwannoma (VS) resection has a critical influence on post-operative facial nerve function. While long-term tumour control is the primary aim of surgery, preservation of facial nerve integrity remains a key determinant of quality of life.
Methods: A retrospective analysis of patients undergoing microsurgical VS was identified at a single UK centre (1990-2024). Approaches included translabyrinthine and retrosigmoid. Data were extracted from notes, operative records, imaging, and follow-up.
The House–Brackmann (HB) function at 12 months was the primary outcome where HB I–II was excellent, HB III–VI poor. Secondary outcomes were CSF complications (pseudomeningocoele, leak, hydrocephalus), early infection (≤30 days), venous sinus thrombosis, and recurrence.
Results: A total of 409 patients were identified. Centre workload increased significantly between 1990-2024 for both retrosigmoid (p = 0.03) and translabyrinthine (p = 0.001) approaches, with a dip during 2020–2022 attributable to the COVID-19 pandemic.
12 month HB were available for 407/409(99.5%); overall, 87% achieved excellent facial function (retrosigmoid 87%, n=318; translabyrinthine 90%, n=89; p=0.55).
Over 34 years, immediate excellent outcomes rose from 64% to 86% (1998–2006 vs 2015–2024; p<0.0001), but 12-month results were similar- 84-90% HB I-II (p=0.46), indicating recovery despite poor immediate HB.
48.36% of patients with poor immediate HB (III–VI) improved to excellent (I–II) by 12 months (p=0.11) and was similar across approaches. Stereotactic radiosurgery (SRS) after VS resection fell from 14% (1990–2014) to 8% (2015–2024) (p=0.06) (13% to 7% - retrosigmoid; 22% to 9% - translabyrinthine). CSF-related complications ranged between 1–5% across subgroups.
| Retrosigmoid 1990-2014 | Retrosigmoid 2015-2024 | Translab 1990-2014 | Translab 2015-2024 | |
| Total N(%) | 219(53.55%) | 99(24.21%) | 32(7.82%) | 57(13.94%) |
| Median Age | 54 | 55 | 57 | 54 |
| Gender M:F | 105:108 | 49:50 | 17:12 | 28:29 |
| HBI-12 months | 162(73.97%) | 72(72.73%) | 22(68.75%) | 44(77.19%) |
| HBII-12 months | 25(11.42%) | 17(17.17%) | 6(18.75%) | 8(14.04%) |
| HBIII-12 months | 17(7.76%) | 6(6.06%) | 2(6.25%) | 3(5.26%) |
| HBIV-12 months | 7(3.20%) | 1(1.01%) | 1(3.12%) | 1(1.75%) |
| HBV-12 months | 5(2.28%) | 2 (2.02%) | 1 (3.12%) | 1 (1.75%) |
| Unrecorded | 3 | |||
| Post VS resection SRS | 29(13%) | 7(7%) | 7(22%) | 5(9%) |
Conclusion: Facial nerve outcomes improved across eras, reflecting evolving microsurgical practice and use of continuous monitoring. Despite variability in immediate HB, 12-month facial function converged to a high rate of HB I–II, underscoring that early postoperative weakness does not necessarily predict long-term function. Selective use of adjuvant SRS appears to be decreasing over time, supporting a strategy of tailored resection with surveillance and salvage therapy to optimise facial nerve preservation.