In the early 1900s until about the mid 1960s, facial nerve preservation was not even a consideration in the treatment of acoustic neuroma. This was due in large part to late diagnosis. Now, facial nerve functional preservation is a priority with the assistance of wonderful imaging technology, a greater awareness among patients and doctors, and a multidisciplinary approach to the treatment of an acoustic neuroma.
There are two types of facial nerve preservation: anatomical preservation, meaning the nerve is not cut, and functional preservation, meaning the nerve will continue to work properly. Anatomical preservation is not a guarantee of function. Functional preservation is the goal of all treatment strategies.
Modern treatment of acoustic neuroma requires delicate attention to facial nerve functional preservation. Functional preservation comes from the dedication in care of a multidisciplinary team of providers including surgeons, radiation therapists, physical therapists and intraoperative neural monitors. A team that is expert in the anatomy and function of the facial nerve is critical, regardless of whether the tumor is treated by surgery or radiation therapy.
In surgery, choices of surgical approach, level of experience and monitoring weigh heavily in the ultimate outcome. Surgeons must be experienced enough to anticipate the position and course of the facial nerve. Additionally, the latest imaging modalities, such as the high-resolution magnetic resonance imaging (MRI) that Keck Medical Center of USC has, allow for the prediction of location of many small tumors.
The course of the facial nerve is equally important when radiation therapy is chosen. Our experienced treatment team determines the appropriate treatment strategy and accomplishes appropriate dosing and targeting. The USC Acoustic Neuroma Center at Keck Medical Center of USC is devoted to the best possible outcomes for our patients. We have compiled the world’s leaders in all aspects of care, including preservation and rehabilitation of the facial nerve.
by Rick A. Friedman, MD, PhD
Director, USC Acoustic Neuroma Center