Search tips
Search criteria 


Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
Skull base surgery. 1994 April; 4(2): 87–92.
PMCID: PMC1656481

Facial Nerve Preservation and Tumor Control After Gamma Knife Radiosurgery of Unilateral Acoustic Tumors


To assess the long-term risk of facial nerve dysfunction after unilateral acoustic tumor stereotactic radiosurgery, we retrospectively analyzed our initial experience in 98 unilateral acoustic tumor patients who were evaluated at least 2 years after treatment. This observation interval permits an analysis of both the risk of onset and the potential for recovery of facial nerve function. The overall risk of developing any degree of delayed transient or permanent postoperative facial neuropathy was 21.4% (21 of 98 patients). Only one patient undergoing radiosurgery alone had poor residual facial nerve dysfunction worse than House-Brackmann grade III. Normal facial nerve function (House-Brackmann grade 1) was preserved in 95% of patients with small tumors (10 mm or less petrous-pons dimension) and in 90% of patients who had useful hearing and normal facial function preoperatively. Normal facial function was preserved in all patients with intracanalicular acoustic tumors. The risk of delayed facial neuropathy was reduced by performing radiosurgery when tumors were small (1000 mm3 or less), by enclosing the tumor within the 50% isodose volume, by using multiple small radiation isocenters, and by detailed identification of the tumor volume using stereotactic magnetic resonance imaging.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985 Apr;93(2):146–147. [PubMed]
  • House JW. Facial nerve grading systems. Laryngoscope. 1983 Aug;93(8):1056–1069. [PubMed]
  • Glasscock ME, 3rd, Dickins JR. Complications of acoustic tumor surgery. Otolaryngol Clin North Am. 1982 Nov;15(4):883–895. [PubMed]
  • Whittaker CK, Luetje CM. Translabyrinthine removal of large acoustic tumors. Am J Otol. 1985 Nov;Suppl:155–160. [PubMed]
  • Lye RH, Dutton J, Ramsden RT, Occleshaw JV, Ferguson IT, Taylor I. Facial nerve preservation during surgery for removal of acoustic nerve tumors. J Neurosurg. 1982 Dec;57(6):739–746. [PubMed]
  • Harner SG, Ebersold MJ. Management of acoustic neuromas, 1978-1983. J Neurosurg. 1985 Aug;63(2):175–179. [PubMed]
  • Smyth GD, Gordon DS, Campbell R, Kerr AG. The facial nerve in acoustic neuroma surgery. J Laryngol Otol. 1982 Apr;96(4):335–346. [PubMed]
  • Sugita K, Kobayashi S. Technical and instrumental improvements in the surgical treatment of acoustic neurinomas. J Neurosurg. 1982 Dec;57(6):747–752. [PubMed]
  • Yasargil MG, Fox JL. The microsurgical approach to acoustic neurinomas. Surg Neurol. 1974 Nov;2(6):393–398. [PubMed]
  • DiTullio MV, Jr, Malkasian D, Rand RW. A critical comparison of neurosurgical and otolaryngological approaches to acoustic neuromas. J Neurosurg. 1978 Jan;48(1):1–12. [PubMed]
  • House WF, Hitselberger WW. Preservation of the facial nerve in acoustic tumor surgery. Arch Otolaryngol. 1968 Dec;88(6):655–658. [PubMed]
  • Tos M, Thomsen J. Translabyrinthine surgery of acoustic neurinoma. Acta Otolaryngol Suppl. 1979;360:45–47. [PubMed]
  • Devriese PP, van der Werf AJ, van der Borden J. Facial nerve function after suboccipital removal of acoustic neurinoma. Arch Otorhinolaryngol. 1984;240(2):193–206. [PubMed]
  • Drake CG. Surgical treatment of acoustic neuroma with preservation or reconstitution of the facial nerve. J Neurosurg. 1967 May;26(5):459–464. [PubMed]
  • Tator CH, Nedzelski JM. Facial nerve preservation in patients with large acoustic neuromas treated by a combined middle fossa transtentorial translabyrinthine approach. J Neurosurg. 1982 Jul;57(1):1–7. [PubMed]
  • Sheptak PE, Jannetta PJ. The two-stage excision of huge acoustic neurinomas. J Neurosurg. 1979 Jul;51(1):37–41. [PubMed]
  • Tos M, Thomsen J. The price of preservation of hearing in acoustic neuroma surgery. Ann Otol Rhinol Laryngol. 1982 May-Jun;91(3 Pt 1):240–245. [PubMed]
  • Ebersold MJ, Harner SG, Beatty CW, Harper CM, Jr, Quast LM. Current results of the retrosigmoid approach to acoustic neurinoma. J Neurosurg. 1992 Jun;76(6):901–909. [PubMed]
  • Norén G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences. Neurosurgery. 1983 Jul;13(1):12–22. [PubMed]
  • Hirsch A, Norén G. Audiological findings after stereotactic radiosurgery in acoustic neurinomas. Acta Otolaryngol. 1988 Sep-Oct;106(3-4):244–251. [PubMed]
  • Lunsford LD, Linskey ME. Stereotactic radiosurgery in the treatment of patients with acoustic tumors. Otolaryngol Clin North Am. 1992 Apr;25(2):471–491. [PubMed]
  • Lunsford LD, Kondziolka D, Flickinger JC. Radiosurgery as an alternative to microsurgery of acoustic tumors. Clin Neurosurg. 1992;38:619–634. [PubMed]
  • Lunsford LD, Kamerer DB, Flickinger JC. Stereotactic radiosurgery for acoustic neuromas. Arch Otolaryngol Head Neck Surg. 1990 Aug;116(8):907–909. [PubMed]
  • Flickinger JC, Lunsford LD, Coffey RJ, Linskey ME, Bissonette DJ, Maitz AH, Kondziolka D. Radiosurgery of acoustic neurinomas. Cancer. 1991 Jan 15;67(2):345–353. [PubMed]
  • Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D. Stereotactic radiosurgery for acoustic tumors. Neurosurg Clin N Am. 1992 Jan;3(1):191–205. [PubMed]
  • Lunsford LD, Flickinger J, Coffey RJ. Stereotactic gamma knife radiosurgery. Initial North American experience in 207 patients. Arch Neurol. 1990 Feb;47(2):169–175. [PubMed]
  • Lunsford LD, Flickinger J, Lindner G, Maitz A. Stereotactic radiosurgery of the brain using the first United States 201 cobalt-60 source gamma knife. Neurosurgery. 1989 Feb;24(2):151–159. [PubMed]
  • Lunsford LD, Maitz A, Lindner G. First United States 201 source cobalt-60 gamma unit for radiosurgery. Appl Neurophysiol. 1987;50(1-6):253–256. [PubMed]
  • Linskey ME, Flickinger JC, Lunsford LD. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustic tumor stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 1993 Jan 15;25(2):227–233. [PubMed]
  • Linskey ME, Lunsford LD, Flickinger JC. Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR Am J Neuroradiol. 1991 Nov-Dec;12(6):1165–1175. [PubMed]
  • Cross JP., Jr Unilateral neurilemmomas of the eighth cranial nerve: then and now. Am J Otol. 1981 Jul;3(1):28–34. [PubMed]
  • Møller AR, Jannetta PJ. Preservation of facial function during removal of acoustic neuromas. Use of monopolar constant-voltage stimulation and EMG. J Neurosurg. 1984 Oct;61(4):757–760. [PubMed]
  • Delgado TE, Bucheit WA, Rosenholtz HR, Chrissian S. Intraoperative monitoring of facila muscle evoked responses obtained by intracranial stimulation of the facila nerve: a more accurate technique for facila nerve dissection. Neurosurgery. 1979 May;4(5):418–421. [PubMed]
  • Shelton C, Brackmann DE, House WF, Hitselberger WE. Middle fossa acoustic tumor surgery: results in 106 cases. Laryngoscope. 1989 Apr;99(4):405–408. [PubMed]
  • Sheline GE, Wara WM, Smith V. Therapeutic irradiation and brain injury. Int J Radiat Oncol Biol Phys. 1980 Sep;6(9):1215–1228. [PubMed]
  • BERGSTROM R. Changes in peripheral nerve tissue after irradiation with high energy protons. Acta radiol. 1962 Aug;58:301–312. [PubMed]
  • Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol. 1988 Jan-Feb;97(1):55–66. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers