Facial nerve outcome in acoustic tumor surgery.

Seventy-three procedures involving 70 acoustic tumors were carried out over 3 years. The majority of tumors (65) were removed by the translabyrinthine approach. Tumor size ranged from 0.5 through 5.0 cm. All patients underwent intraoperative facial nerve monitoring: 22 patients developed immediate facial palsy (House-Brackmann grades II-VI); 11 patients recovered completely; 11 patients (15.7%) had persistent paralysis. The incidence of long-term, poor outcome (H-B grade IV-VI) was 5.7 percent. The overall incidence of facial palsy was not found to be related to tumor size; however, facial paralysis associated with large tumors exhibited a poorer House-Brackmann grade compared to small and medium lesions. The use of intraoperative facial monitoring has enhanced the surgeon's ability to preserve facial nerve function by reducing the overall incidence of postoperative facial paralysis.