Cirurgia de Schwannoma do nervo vestibular ou cirurgia de preservação do nervo facial

The authors review the evolution of the surgical strategy regarding vestibular nerve schwannomas. The classic neurosurgical goal aims to remove the tumor completely. Presently, we believe this approach has changed significantly. Both the preservation of the facial nerve and tumor resection are the main objectives of the surgery. In this review, we place a special emphasis to the management of large tumors (grade 3 and 4 of Koos Scale) and the quality of life of patients after the surgery. We describe an innovative imaging technique used in Portugal, which is performed at the Lusiadas Hospital, in Lisbon. All the patients treated at the Skull Base and Neurorhinology Department of the Hospital de Egas Moniz (Lisbon) are pre-surgically evaluated by MRI and Diffusion Tensor Imaging. Diffusion Tensor Imaging allows to determine the location of the facial nerve by means of Tractography. Cranial nerve Tractography contribute to successful skull base otoneurosurgeries, particularly by lowering the risk of nerve injury during cerebellopontine angle surgeries and reducing the time spent to locate fiber bundles intra-operatively.