A Clinical Study on Surgical Outcome of Acoustic Neuroma in Relation to Tumour Size and Facial Nerve Involvement Using House Brackmann Grading

Aim: To evaluate surgical outcome of acoustic neuroma in relation to tumour size and facial nerve involvement using House Brackmann Grading. Material and Method: The present prospective study was conducted at Department of Neurosurgery, Nilratan Sircar Medical College & Hospital, Kolkata among 30 consecutive patients admitted with unilateral Acoustic Schwannoma from May 2019 to November 2020. The surgical management was done in two stages;-in first stage the patients were subjected to venticulo-peritonial shunting to relieve the raised intra cranial pressure (ICP) and in second stage the excision of tumor was done through Retrosigmoid approach. After the management of post operative period the patient was discharged with advice for regular follow up in outpatient department. Post-operative outcome of facial nerve function was assessed by House Brackmann Scale. Results: 23.33%, 50% and 26.67% of the subjects were having tumour size of less than2cm, 2-4cm and greater than4cm respectively. The gross total resection was done in 83.33% (n=25) cases and subtotal done in 16.67% (n=5) cases.6 months after surgery, facial nerve function of grade I-II, III-IV and V-VI was present in 18 (62.07%), 4 (13.79%) and 7 (24.14%) subjects respectively. All the cases in were having I-II HB grade. Mortality was reported in 1 (12.5%) subjects from group 3. Conclusion: The retromastoid approach can be utilized in excision of small, medium and large size acoustic schwanoma and prior to undertaking a complete excision a Ventriculo-peritoneal shunting can be done on emergency basis to counteract the raised intracranial pressure. Leading to good neurological outcome.