Comparison of postoperative facial nerve outcomes between translabyrinthine and retrosigmoid approaches in matched-pair patients

Objectives/Hypothesis: The objective was to assess whether the translabyrinthine approach for acoustic tumor removal offers better postoperative facial nerve function compared with the retrosigmoid approach. Study Design: Retrospective case review from a tertiary otology referral center. Methods: Patients who had undergone either retrosigmoid or translabyrinthine approach for removal of acoustic neuroma from January 1, 1980, to December 31, 1999, were included in the study. Two groups of patients were created, one containing retrosigmoid cases and the other, translabyrinthine. Attempts were made to match each retrosigmoid case to a translabyrinthine case with regard to tumor size, patient age, and date of operation. This matching served to eliminate these variables from influencing postoperative facial nerve outcomes. From an initial pool of 450 patients, 35 pairs of patients were matched for the study. Facial nerve functions were reported at immediate, 3-month, and 1-year postoperative periods. Results: Patient demographics demonstrated that matched patients had almost identical tumor size, patient age, and date of operation. Comparisons of postoperative facial nerve functions between the matched groups revealed that retrosigmoid approach carried 2.86 times higher risk of facial nerve dysfunction during the immediate postoperative period. However, by 1 year, the facial nerve outcomes were similar between the two groups. Conclusion: Compared with the translabyrinthine approach, retrosigmoid approach carries a higher risk of postoperative facial nerve dysfunction during the immediate postoperative period. However, long-term facial nerve outcomes are identical between the two approaches.