{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:41:54Z","timestamp":1790174514179,"version":"4.1.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>In large vestibular schwannoma (VS) surgery, the facial nerve (FN) is at high risk of injury. Near-total resection has been advocated in the case of difficult facial nerve dissection, but the amount of residual tumor that should be left and when dissection should be stopped remain controversial factors. The objective of this study was to report FN outcome and radiological results in patients undergoing near-total VS resection guided by electromyographic supramaximal stimulation of the FN at the brainstem.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This study was a retrospective analysis of a prospectively maintained database. Inclusion criteria were surgical treatment of a large VS during 2014, normal preoperative FN function, and an incomplete resection due to the strong adherence of the tumor to the FN and the loss of around 50% of the response of supramaximal stimulation of the proximal FN at 2 mA. Facial nerve function and the amount and evolution of the residual tumor were evaluated by clinical examination and by MRI at a mean of 5 days postoperatively and at 1 year postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Twenty-five patients met the inclusion criteria and were included in the study. Good FN function (Grade I or II) was observed in 16 (64%) and 21 (84%) of the 25 patients at Day 8 and at 1 year postoperatively, respectively. At the 1-year follow-up evaluation (n = 23), 15 patients (65%) did not show growth of the residual tumor, 6 patients (26%) had regression of the residual tumor, and only 2 patients (9%) presented with tumor progression.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Near-total resection guided by electrophysiology represents a safe option in cases of difficult dissection of the facial nerve from the tumor. This seems to offer a good compromise between the goals of preserving facial nerve function and achieving maximum safe resection.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.11.jns161737","type":"journal-article","created":{"date-parts":[[2017,4,14]],"date-time":"2017-04-14T15:15:04Z","timestamp":1492182904000},"page":"903-910","source":"Crossref","is-referenced-by-count":36,"title":["Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas"],"prefix":"10.3171","volume":"128","author":[{"given":"Daniele","family":"Bernardeschi","sequence":"first","affiliation":[{"name":"Departments of Otology, Auditory Implants, and Skull Base Surgery,"},{"name":"Sorbonne Universit\u00e9s, UPMC Universit\u00e9 Paris VI; and"},{"name":"Inserm UMR-S1159, R\u00e9habilitation Chirurgicale Mini-Invasive et Robotis\u00e9e de L'Audition, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadya","family":"Pyatigorskaya","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9s, UPMC Universit\u00e9 Paris VI; and"},{"name":"Neuroradiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Vanier","sequence":"additional","affiliation":[{"name":"Biostatistics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franck","family":"Bielle","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9s, UPMC Universit\u00e9 Paris VI; and"},{"name":"Neuropathology, AP-HP, H\u00f4pitaux Universitaires Piti\u00e9 Salp\u00eatri\u00e8re\u2013Charles Foix;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustapha","family":"Smail","sequence":"additional","affiliation":[{"name":"Departments of Otology, Auditory Implants, and Skull Base Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georges","family":"Lamas","sequence":"additional","affiliation":[{"name":"Departments of Otology, Auditory Implants, and Skull Base Surgery,"},{"name":"Sorbonne Universit\u00e9s, UPMC Universit\u00e9 Paris VI; and"},{"name":"Inserm UMR-S1159, R\u00e9habilitation Chirurgicale Mini-Invasive et Robotis\u00e9e de L'Audition, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Sterkers","sequence":"additional","affiliation":[{"name":"Departments of Otology, Auditory Implants, and Skull Base Surgery,"},{"name":"Sorbonne Universit\u00e9s, UPMC Universit\u00e9 Paris VI; and"},{"name":"Inserm UMR-S1159, R\u00e9habilitation Chirurgicale Mini-Invasive et Robotis\u00e9e de L'Audition, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Kalamarides","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9s, UPMC Universit\u00e9 Paris VI; and"},{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns161737","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1177\/019459989310800303","article-title":"Predicting long-term facial nerve outcome after acoustic neuroma surgery","volume":"108","author":"Arriaga MA,","year":"1993","unstructured":"Arriaga MA, Luxford WM, Atkins JS Jr, Kwartler JA: Predicting long-term facial nerve outcome after acoustic neuroma surgery. 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