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December 1968

Preservation of the Facial Nerve in Acoustic Tumor Surgery

Author Affiliations

Los Angeles
From the Otologic Medical Group, Los Angeles.

Arch Otolaryngol. 1968;88(6):655-658. doi:10.1001/archotol.1968.00770010657014

THE FACIAL nerve is the key that opens the door to early surgical removal of acoustic neuromas.

Cushing was not too concerned with the facial nerve, since partial tumor removal rarely affected the nerve. Dandy, however, by 1925 was dealing with less advanced lesions and correctly advocated total removal of the lesion to prevent the high mortality of recurrence surgery. With these total removals came the problem of facial paralysis.

Diagnostic acumen continued to improve, and by 1950 tumors were being diagnosed at a much less advanced stage than those seen by Dandy.

In 1950, Penneybaker and Cairns recommended a policy of watchful expectation in early acoustic neuromas. Why trade a moderate hearing loss for a facial paralysis, total hearing loss, and possible ataxia? It could be a still more expensive trade to wait until a patient's symptoms became so severe that surgery could not make him any worse. When

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