Facial nerve involvement in patients with acoustic neurinomas. Examination with magnetic single- and bi-stimulation.

The diagnosis of acoustic neurinomas is usually made by auditory and vestibular testing and magnetic resonance imaging. As clinical involvement of the facial nerve is infrequent, occurring only in large tumours, only little is known about the subclinical involvement of the facial nerve. Transcranial magnetic stimulation of the VIIth cranial nerve in the temporal bone, adjacent to acoustic neurinoma growth, seems to be an adequate instrument for electrophysiological measurements of minimal nerve lesions without clinically obvious facial palsy. In 70% out of 97 patients with surgically and histologically confirmed acoustic neurinomas, obvious elongation of the intratemporal conduction time of the facial nerve was found. This affection was dependent on tumour size. No correlation was found to preoperative or postoperative facial nerve function and hearing function. The latencies of the conduction time showed a tendential increase in patients with a more difficult grade of surgery and of facial nerve preparation due to fibrous adhesions and nerve spreading on the tumour capsule. A completely new stimulation modality, the application of two magnetic stimuli in quick succession, was applied for the first time in acoustic neurinoma patients, and revealed facial nerve involvement by acoustic neurinoma growth. Facial nerve involvement in acoustic neurinoma can be detected by transcranial magnetic stimulation even in patients with small and medium sized tumours but with clinically normal facial function.