Following vestibular schwannoma excision, a subset of cases has been reported in which hearing is present immediately after surgery, but is lost in the early postoperative period. Such cases have rarely been reported, and the postoperative audiological data collected from patients in these cases lacks the time resolution necessary to determine the pathophysiological mechanism responsible for the pattern of hearing loss. The present study aimed to more clearly define delayed hearing loss by collecting detailed data documenting changes in behavioural and electrophysiological auditory responses following vestibular schwannoma surgery. In particular, we aimed to use this data to determine the time course of changes in auditory function and to identify whether the site of impairment was cochlear or neural. Preoperative and daily postoperative monitoring of auditory function was performed in 19 patients undergoing vestibular schwannoma excision via the retrosigmoid approach at Christchurch Public Hospital. The pre- and postoperative assessment battery included pure-tone and speech audiometry, tympanometry, tone decay, distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR) measurement. Intraoperative ABR was performed in four cases in which clear preoperative waveforms were present. Transtympanic electrocochleography (ECochG) was carried out if wave I was lost in the early postoperative period. Thirteen of the 19 patients suffered immediate anacusis following surgery and six had measurable hearing postoperatively. The behavioural and electrophysiological data collected in each case is discussed with regard to the likely pathophysiology of pre- and postoperative hearing loss. No patients demonstrated behavioural evidence of delayed hearing loss, however a gradual deterioration of ABR in the early postoperative period was observed in Case 16. ECochG and DPOAEs in this case indicated the presence of cochlear function although the patient presented with immediate postoperative anacusis in the ipsilateral ear. These results are consistent with postoperative retrograde degeneration of the cochlear nerve.

Following vestibular schwannoma excision, a subset of cases has been reported in which hearing is present immediately after surgery, but is lost in the early postoperative period. Such cases have rarely been reported, and the postoperative audiological data collected from patients in these cases lacks the time resolution necessary to determine the pathophysiological mechanism responsible for the pattern of hearing loss. The present study aimed to more clearly define delayed hearing loss by collecting detailed data documenting changes in behavioural and electrophysiological auditory responses following vestibular schwannoma surgery. In particular, we aimed to use this data to determine the time course of changes in auditory function and to identify whether the site of impairment was cochlear or neural. Preoperative and daily postoperative monitoring of auditory function was performed in 19 patients undergoing vestibular schwannoma excision via the retrosigmoid approach at Christchurch Public Hospital. The pre- and postoperative assessment battery included pure-tone and speech audiometry, tympanometry, tone decay, distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR) measurement. Intraoperative ABR was performed in four cases in which clear preoperative waveforms were present. Transtympanic electrocochleography (ECochG) was carried out if wave I was lost in the early postoperative period. Thirteen of the 19 patients suffered immediate anacusis following surgery and six had measurable hearing postoperatively. The behavioural and electrophysiological data collected in each case is discussed with regard to the likely pathophysiology of pre- and postoperative hearing loss. No patients demonstrated behavioural evidence of delayed hearing loss, however a gradual deterioration of ABR in the early postoperative period was observed in Case 16. ECochG and DPOAEs in this case indicated the presence of cochlear function although the patient presented with immediate postoperative anacusis in the ipsilateral ear. These results are consistent with postoperative retrograde degeneration of the cochlear nerve.

Dissertação (mestrado) - Pontifícia Universidade Católica do Paraná, Curitiba, 2010 / Bibliografia: f. 44-47 / Introdução: existe uma controvérsia sobre o quanto do conduto auditivo interno (CAI) é possível se expor, para a remoção completa de um schwannoma do vestibular (SV), através do acesso retrossigmóide transmeatal (RT). Neurocirurgiões que utilizam essa abo / Introduction: there is a controversy over how much of the internal auditory canal (IAC) can be exposed and complete removal of a vestibular schwannoma (VS) in this region through the transmeatal retrosigmoid access (TR). Neurosurgeons using this surgical

Nas cirurgias de ressecção de tumores do ângulo pontocerebelar, a preservação do nervo facial está entre os seus principais objetivos. Diversas técnicas neurofisiológicas vêm sendo empregadas com o objetivo de predizer déficit imediato do nervo facial no pós-operatório, como a eletromiografia contínua para registro de atividade neurotônica tipo A, a estimulação direta do nervo facial no sítio tumoral e a estimulação elétrica transcraniana com captação em músculos de face. Analisamos 23 pacientes de forma prospectiva, submetidos à cranectomia retrossigmoide para ressecção de tumores em fossa posterior no período de janeiro de 2008 a março de 2010. Os pacientes foram avaliados clinicamente de acordo com a gradação de House-Brackmann para a função do nervo facial. Foram observadas a ocorrência de atividade neurotônica do tipo A, também chamada de atividade irritativa, a queda da amplitude do potencial motor do nervo facial obtido com a estimulação elétrica transcraniana e o aumento na intensidade do estímulo elétrico da estimulação elétrica transcraniana para a obtenção desse potencial. Esses dados foram relacionados à condição clínica do nervo facial no pós-operatório imediato e na última data de acompanhamento. Observamos que a queda da amplitude do nervo facial acima de 60% do seu valor inicial basal foi a variável mais sensível (89%) e com maior valor preditivo positivo (92%) para a piora clínica do nervo facial. A ocorrência de atividade irritativa isolada foi a variável menos sensível (7%) e com valor preditivo positivo de apenas 25%. O aumento na intensidade da estimulação elétrica transcraniana não mostrou significância estatística (p = 0,287). Concluímos que das variáveis estudadas, a queda na amplitude do potencial evocado motor do 7º nervo craniano acima de 60% foi a melhor na predição de piora clínica imediata do nervo facial / The preservation of facial nerve function is one of the most important goals of the cerebellopontine angle tumor resection surgeries. Valuable neurophysiologic techniques have been used to predict the facial nerve outcome, such as continuous electromyography to identify neurotonic activity type A, direct facial nerve stimulation in the vicinity of the tumor and transcranial motor evoked potential recording in face muscles. We analyzed 23 patients undergoing retrossigmoidectomy approaches for posterior fossa tumor resection between January 2008 and March 2010. Their facial nerve function was evaluated using the House-Brackmann score. We correlated the occurrence of type A neurotonic activity, facial nerve motor evoked potential amplitude obtained with transcranial electrical stimulation and increase in the electric stimulus threshold to the immediate and last follow-up facial nerve outcome. In this series, the increase in electric stimulus threshold showed no statistical significance (p = 0,287). The drop of the facial nerve motor evoked potential amplitude equal or above 60% was the most sensitive (89%) and with the highest positive predictive value (92%) in identifying poor facial nerve outcome. The occurrence of neurotonic activity type A showed to be the least sensitive (7%) and with the poorest positive predictive value (25%) of them. We conclude that among the used parameters, the drop of the final 7º nerve motor evoked potential amplitude equal or above 60% of basal recording was the best one in predicting poor facial nerve outcome

Nas cirurgias de ressecção de tumores do ângulo pontocerebelar, a preservação do nervo facial está entre os seus principais objetivos. Diversas técnicas neurofisiológicas vêm sendo empregadas com o objetivo de predizer déficit imediato do nervo facial no pós-operatório, como a eletromiografia contínua para registro de atividade neurotônica tipo A, a estimulação direta do nervo facial no sítio tumoral e a estimulação elétrica transcraniana com captação em músculos de face. Analisamos 23 pacientes de forma prospectiva, submetidos à cranectomia retrossigmoide para ressecção de tumores em fossa posterior no período de janeiro de 2008 a março de 2010. Os pacientes foram avaliados clinicamente de acordo com a gradação de House-Brackmann para a função do nervo facial. Foram observadas a ocorrência de atividade neurotônica do tipo A, também chamada de atividade irritativa, a queda da amplitude do potencial motor do nervo facial obtido com a estimulação elétrica transcraniana e o aumento na intensidade do estímulo elétrico da estimulação elétrica transcraniana para a obtenção desse potencial. Esses dados foram relacionados à condição clínica do nervo facial no pós-operatório imediato e na última data de acompanhamento. Observamos que a queda da amplitude do nervo facial acima de 60% do seu valor inicial basal foi a variável mais sensível (89%) e com maior valor preditivo positivo (92%) para a piora clínica do nervo facial. A ocorrência de atividade irritativa isolada foi a variável menos sensível (7%) e com valor preditivo positivo de apenas 25%. O aumento na intensidade da estimulação elétrica transcraniana não mostrou significância estatística (p = 0,287). Concluímos que das variáveis estudadas, a queda na amplitude do potencial evocado motor do 7º nervo craniano acima de 60% foi a melhor na predição de piora clínica imediata do nervo facial / The preservation of facial nerve function is one of the most important goals of the cerebellopontine angle tumor resection surgeries. Valuable neurophysiologic techniques have been used to predict the facial nerve outcome, such as continuous electromyography to identify neurotonic activity type A, direct facial nerve stimulation in the vicinity of the tumor and transcranial motor evoked potential recording in face muscles. We analyzed 23 patients undergoing retrossigmoidectomy approaches for posterior fossa tumor resection between January 2008 and March 2010. Their facial nerve function was evaluated using the House-Brackmann score. We correlated the occurrence of type A neurotonic activity, facial nerve motor evoked potential amplitude obtained with transcranial electrical stimulation and increase in the electric stimulus threshold to the immediate and last follow-up facial nerve outcome. In this series, the increase in electric stimulus threshold showed no statistical significance (p = 0,287). The drop of the facial nerve motor evoked potential amplitude equal or above 60% was the most sensitive (89%) and with the highest positive predictive value (92%) in identifying poor facial nerve outcome. The occurrence of neurotonic activity type A showed to be the least sensitive (7%) and with the poorest positive predictive value (25%) of them. We conclude that among the used parameters, the drop of the final 7º nerve motor evoked potential amplitude equal or above 60% of basal recording was the best one in predicting poor facial nerve outcome

The mature central nervous system (CNS) has the capacity to reorganise when there is a change in sensory input. However, studies using the N1 cortical auditory evoked potential, or its magnetic homolog N1m, have not consistently demonstrated evidence of plasticity in adults with late onset unilateral deafness. In addition, little is known about the time course of experience-related plasticity in adults with unilateral deafness. The aim of the studies described in this thesis was to investigate plasticity in adults with unilateral deafness, using N1 auditory evoked potentials. Deafness occurred as a result of surgery for the removal of an acoustic neuroma. The stimuli were 500-Hz and 4-kHz tones presented monaurally to the intact ear, and the data were analysed using global field power and dipole source analysis. In the first study (Chapter 3), hemispheric asymmetries in the N1 response were measured in a group of 24 normally hearing adults at presentation levels of 40, 60 and 80 dB sensation level (SL). The results revealed that the mean hemispheric asymmetry was greater for the 4-kHz stimulus but there was no significant effect of presentation level. In addition, the results revealed that the magnitude of hemispheric asymmetry depended on the ear of stimulation; a trend for larger asymmetries was observed following stimulation of the left ear. The results of the study provide confidence that the methodology is suitable for measuring hemispheric asymmetries in individuals with unilateral deafness. The effect of stimulus level is important since this will vary in plasticity studies involving individuals with late onset unilateral deafness due to their pure tone sensitivity thresholds. Clarifying the effect of stimulus frequency in normally hearing adults is important since the effect of stimulus frequency on plasticity following unilateral deafness has not been reported previously.In the second study (Chapter 4), N1 responses were measured in 19 adults with unilateral deafness (10 and 9 right- and left-sided deafness respectively). Stimuli were typically presented at 60 dB SL. The results revealed that there was significantly greater mean activity and a shift towards reduced hemispheric asymmetries compared with 19 audiogram-matched controls. Similar changes were apparent after both right- and left-sided deafness, and for both 500-Hz and 4-kHz stimuli. Therefore the results reveal evidence of experience-related plasticity that mirrors the findings reported in animal models. The reduced hemispheric asymmetries were reflected in the dipole source model used in this thesis by changes in dipole strength, location and orientation. These findings may explain the inconsistencies reported in previous studies that have used N1 or N1m, where dipole location and orientation have not always been taken into adequate consideration.In the third study (Chapter 5), longitudinal measurements were made in six adults just prior to the onset of complete unilateral deafness, and at 1-, 3- and 6-months after the onset (4 right-sided and 2 left-sided deafness respectively). The results from the second study were further analysed by splitting the data into two groups: nine participants with <2 years deafness and 10 with ≥2 year's deafness. The results from the longitudinal data revealed that there was a significant difference in mean activity across the four conditions. For both stimulus types an increase in mean activity occurred after the onset of deafness, and hemispheric asymmetries were reduced. The biggest changes occurred within 1-month, although further increases were noted in some individuals with ≥2 year's duration of deafness. Changes that continue over this period of time suggest different physiological mechanisms for plasticity within the human central auditory system.

Introdução: O schwannoma vestibular (SV) é um tumor benigno que se origina na bainha de schwann de um dos nervos vestibulares. De acordo com sua topografia lesões nos nervos cranianos facial, trigêmeo, coclear e bulbares podem estar presentes. Apesar do conhecimento da possibilidade de lesão nos nervos cranianos bulbares, a condução de estudos com o intuito de identificar alterações funcionais relacionadas raramente é estudada. Objetivos: Analisar fatores prognósticos de resultados funcionais relacionados aos nervos cranianos facial, trigêmeo, coclear e bulbares e correlacionar o prognóstico fonoaudiológico com os resultados de escalas funcionais finais dos nervos cranianos avaliados. Metodologia: Trata-se de um estudo de coorte com coleta de dados parcialmente retrospectiva que analisa a incidência de déficits funcionais de nervos cranianos em pacientes submetidos à exérese de SV, por meio de um protocolo de avaliação clínica estruturado (PAEC) especificamente para este estudo. O PAEC foi constituído de 2 sessões, sendo a primeira referente aos fatores prognósticos de sequelas e a segunda com dados funcionais referentes à deficiência auditiva (DA), comprometimento neurológico global (CNG), paralisia facial periférica (PFP), disfagia (DG) e fonação (DF). A coleta de dados foi realizada durante os meses de janeiro a junho do ano de 2016 no ambulatório de tumores da divisão de neurologia funcional do instituto de psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A análise dos dados foi realizada por meio do software SPSS de modo inferencial univariado e multivariado adotando um p valor inferior a 0.05. Resultados: A amostra foi composta por 101 sujeitos, sendo 77,2% do sexo feminino e 22,8% do sexo masculino. A média de idade correspondeu à 47,1 anos. Foram identificados 20,8% pacientes portadores de neurofibromatose do tipo 2 (NTFII). A via de acesso cirúrgico preferencial foi a retrossigmoidea (92,1%) com média tumoral igual a 3,4cm.70% dos pacientes apresentaram ressecção total do tumor com uma única abordagem. Na análise univariada foram identificados os fatores preditivos de sequela por desfecho estatisticamente significantes tamanho tumoral, presença de neurofibromatose e ressecção total respectivamente- CNG ( < 0,001; 0,023; 0,010), DG (pvalor < 0,001; pvalor 0,007; pvalor < 0,001), DF (pvalor 0,013; pvalor 0,002), confirmados pela análise multivariada respectiva - CNG (Odds Ratio (OD) 1,5 - pvalor 0,07; OR 3,5 - pvalor 0,036; OR 2,4- pvalor 0,08), DG (OR 2,3 - pvalor 0,006; OR 5,7 - pvalor 0,015; OR 3,9 - pvalor 0,018) e DF (OR 1,6 -pvalor 0,062; OR 5,5 - pvalor 0,006). Para o desfecho PFP a análise univariada foi estatisticamente significante para NTFII (pvalor 0,009) e PFP prévia (pvalor < 0,001) confirmados pela análise multivariada (OR 24,6 - pvalor 0,009; OR 0,3 - pvalor < 0,001), neste desfecho foi realizado estudo correlacional entre as escalas funcionais de DG (pvalor < 0,001) e CNG (pvalor < 0,001) com resultados estatisticamente significantes para a correlação entre os desfechos. Os sinais clínicos da deglutição estatisticamente relevantes corresponderam em 44,4% fase preparatória oral e oral e 66,6% fase faríngea. Conclusões: Os fatores prognósticos significativos relacionados aos déficits funcionais encontrados neste trabalho foram o tamanho do tumor e presença de NFT II em todos os desfechos estudados. Para CNG e DG foi evidenciado ainda o fator preditor de tipo de ressecção estatisticamente significante. Os déficits funcionais de paralisia facial periférica se correlacionaram aos déficits da deglutição em fase oral e fase faríngea e de incapacidade funcional / Introduction: Vestibular schwannoma (VS) is a benign tumor that originates in the schwann sheath of one of the vestibular nerves. According to their topography lesions in the cranial, facial, trigeminal, cochlear and bulbar pairs may be present. Although knowledge of the possibility of injury in the lower cranial nerves, the conduction of studies with the purpose of identifying related functional alterations are rarely studied. Objectives: To analyze prognostic factors of functional results related to facial, trigeminal, cochlear and bulbary cranial nerves and to correlate the final functional prognosis of the cranial nerves with each other. Methodology: This is a cohort study with partial retrospective data collection that analyzes the incidence of functional deficits of cranial nerves in patients submitted to SV excision, using a structured clinical evaluation protocol (PAEC) specifically for this study . The PAEC consisted of 2 sessions, the first one referring to prognostic factors of sequelae and the second with functional data regarding hearing loss (DA), global neurological impairment (CNG), peripheral facial paralysis (PFP), dysphagia (DG) and Phonation (DF). The data collection was performed during the months of January to June of the year 2016 in the ambulatory of acoustic neurinoma of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo. Data analysis was performed using univariate and multivariate inferential mode SPSS software, adopting a value of less than 0.05. Results: The sample consisted of 101 subjects, being 77.2% female and 22.8% male. The mean age was 47.1 years. 20.8% of patients with neurofibromatosis type 2 (NTFII) were identified. The preferred surgical access route was retrossigmoid (92.1%) with a mean tumor equal to 3.4cm.70% of the patients presented total tumor resection with a single approach. In the univariate analysis, the predictive sequelae factors were identified by statistically significant tumor size, presence of neurofibromatosis and total resection, respectively - CNG ( < 0.001; 0.023; 0.010), DG (pvalor < 0.001, pvalor 0.007, pvalor < 0.001), DF (Odds ratio 0.05, pvalor 0.013, pvalor 0.002), confirmed by the respective multivariate analysis - CNG (Odds Ratio (OD) 1.5 - pvalor 0.07, OR 3.5 - pvalor 0.036, OR 2.4 - pvalor 0.08), DG (OR 2.3 - pvalor 0.006; OR 5.7 - Pvalor 0.015, OR 3.9 - pvalor 0.018) and DF (OR 1.6 -value 0.062, OR 5.5 - pvalor 0.006). For the PFP endpoint, the univariate analysis was statistically significant for NTFII (pvalor 0.009) and previous PFP (pvalor < 0.001) confirmed by the multivariate analysis (OR 24.6 - pvalor 0.009; OR 0.3 - pvalor < 0.001). The functional scales of DG (pvalor < 0.001) and CNG (pvalor < 0.001) with statistically significant results for the correlation between the outcomes. Significant clinical signs of swallowing corresponded in 44.4% oral and oral preparatory phase and 66.6% pharyngeal phase. Conclusions: The significant prognostic factors related to the functional deficits found in this study were tumor size, NFT II presence and resection type in all the outcomes studied. Functional deficits of peripheral facial paralysis were correlated with oral and pharyngeal deglutition deficits and functional disability

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

INTRODUCTION: Asymmetrical sensorineural hearing loss [ASNHL] is a common otological complaint. Vestibular schwannoma [VS] is a rare, benign tumor that commonly presents with ASNHL. Magnetic resonance imaging [MRI] is the gold standard in diagnosing VS, but is an expensive imaging modality. Therefore, this meta-analysis evaluates the diagnostic yield of MRI scans in patients with ASNHL to rule out VS. METHODS: A systematic review was performed using a keyword search on the PubMed Database. We excluded articles based on: Non-English, case reports, wrong diagnostic test, solely pediatric subjects, inadequate/unnecessary data, repeated studies, and unclear presenting symptoms. The demographics, definition of ASNHL, and the number and results of MRIs were collected. Positive MRIs were grouped based on differences in interaural hearing loss. RESULTS: 5,783 MRIs on subjects with ASNHL were collected from fourteen studies. 296 MRI scans (5.1%) were positive for VS. 170 positive scans were grouped. In Group A (10+ dB) 11.2% had VS; in Group B (15+ dB at &#8805;2 frequencies or 20+ dB at 1 frequency) 6.5% had VS, Group C (20+ dB) yielded 5.1% with VS, and Group D (30+ dB) had 0.7% yield of positive VS. CONCLUSION: MRI scans to rule out VS in patients with ASNHL has an extremely low diagnostic yield when assessing subjects on the basis of ASNHL. The degree of ASNHL does not correlate with increased odds of VS diagnosis. Overall, the risk of VS diagnosis in patients with any degree of ASNHL is low.

Introdução: O schwannoma vestibular (SV) é um tumor benigno que se origina na bainha de schwann de um dos nervos vestibulares. De acordo com sua topografia lesões nos nervos cranianos facial, trigêmeo, coclear e bulbares podem estar presentes. Apesar do conhecimento da possibilidade de lesão nos nervos cranianos bulbares, a condução de estudos com o intuito de identificar alterações funcionais relacionadas raramente é estudada. Objetivos: Analisar fatores prognósticos de resultados funcionais relacionados aos nervos cranianos facial, trigêmeo, coclear e bulbares e correlacionar o prognóstico fonoaudiológico com os resultados de escalas funcionais finais dos nervos cranianos avaliados. Metodologia: Trata-se de um estudo de coorte com coleta de dados parcialmente retrospectiva que analisa a incidência de déficits funcionais de nervos cranianos em pacientes submetidos à exérese de SV, por meio de um protocolo de avaliação clínica estruturado (PAEC) especificamente para este estudo. O PAEC foi constituído de 2 sessões, sendo a primeira referente aos fatores prognósticos de sequelas e a segunda com dados funcionais referentes à deficiência auditiva (DA), comprometimento neurológico global (CNG), paralisia facial periférica (PFP), disfagia (DG) e fonação (DF). A coleta de dados foi realizada durante os meses de janeiro a junho do ano de 2016 no ambulatório de tumores da divisão de neurologia funcional do instituto de psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A análise dos dados foi realizada por meio do software SPSS de modo inferencial univariado e multivariado adotando um p valor inferior a 0.05. Resultados: A amostra foi composta por 101 sujeitos, sendo 77,2% do sexo feminino e 22,8% do sexo masculino. A média de idade correspondeu à 47,1 anos. Foram identificados 20,8% pacientes portadores de neurofibromatose do tipo 2 (NTFII). A via de acesso cirúrgico preferencial foi a retrossigmoidea (92,1%) com média tumoral igual a 3,4cm.70% dos pacientes apresentaram ressecção total do tumor com uma única abordagem. Na análise univariada foram identificados os fatores preditivos de sequela por desfecho estatisticamente significantes tamanho tumoral, presença de neurofibromatose e ressecção total respectivamente- CNG ( < 0,001; 0,023; 0,010), DG (pvalor < 0,001; pvalor 0,007; pvalor < 0,001), DF (pvalor 0,013; pvalor 0,002), confirmados pela análise multivariada respectiva - CNG (Odds Ratio (OD) 1,5 - pvalor 0,07; OR 3,5 - pvalor 0,036; OR 2,4- pvalor 0,08), DG (OR 2,3 - pvalor 0,006; OR 5,7 - pvalor 0,015; OR 3,9 - pvalor 0,018) e DF (OR 1,6 -pvalor 0,062; OR 5,5 - pvalor 0,006). Para o desfecho PFP a análise univariada foi estatisticamente significante para NTFII (pvalor 0,009) e PFP prévia (pvalor < 0,001) confirmados pela análise multivariada (OR 24,6 - pvalor 0,009; OR 0,3 - pvalor < 0,001), neste desfecho foi realizado estudo correlacional entre as escalas funcionais de DG (pvalor < 0,001) e CNG (pvalor < 0,001) com resultados estatisticamente significantes para a correlação entre os desfechos. Os sinais clínicos da deglutição estatisticamente relevantes corresponderam em 44,4% fase preparatória oral e oral e 66,6% fase faríngea. Conclusões: Os fatores prognósticos significativos relacionados aos déficits funcionais encontrados neste trabalho foram o tamanho do tumor e presença de NFT II em todos os desfechos estudados. Para CNG e DG foi evidenciado ainda o fator preditor de tipo de ressecção estatisticamente significante. Os déficits funcionais de paralisia facial periférica se correlacionaram aos déficits da deglutição em fase oral e fase faríngea e de incapacidade funcional / Introduction: Vestibular schwannoma (VS) is a benign tumor that originates in the schwann sheath of one of the vestibular nerves. According to their topography lesions in the cranial, facial, trigeminal, cochlear and bulbar pairs may be present. Although knowledge of the possibility of injury in the lower cranial nerves, the conduction of studies with the purpose of identifying related functional alterations are rarely studied. Objectives: To analyze prognostic factors of functional results related to facial, trigeminal, cochlear and bulbary cranial nerves and to correlate the final functional prognosis of the cranial nerves with each other. Methodology: This is a cohort study with partial retrospective data collection that analyzes the incidence of functional deficits of cranial nerves in patients submitted to SV excision, using a structured clinical evaluation protocol (PAEC) specifically for this study . The PAEC consisted of 2 sessions, the first one referring to prognostic factors of sequelae and the second with functional data regarding hearing loss (DA), global neurological impairment (CNG), peripheral facial paralysis (PFP), dysphagia (DG) and Phonation (DF). The data collection was performed during the months of January to June of the year 2016 in the ambulatory of acoustic neurinoma of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo. Data analysis was performed using univariate and multivariate inferential mode SPSS software, adopting a value of less than 0.05. Results: The sample consisted of 101 subjects, being 77.2% female and 22.8% male. The mean age was 47.1 years. 20.8% of patients with neurofibromatosis type 2 (NTFII) were identified. The preferred surgical access route was retrossigmoid (92.1%) with a mean tumor equal to 3.4cm.70% of the patients presented total tumor resection with a single approach. In the univariate analysis, the predictive sequelae factors were identified by statistically significant tumor size, presence of neurofibromatosis and total resection, respectively - CNG ( < 0.001; 0.023; 0.010), DG (pvalor < 0.001, pvalor 0.007, pvalor < 0.001), DF (Odds ratio 0.05, pvalor 0.013, pvalor 0.002), confirmed by the respective multivariate analysis - CNG (Odds Ratio (OD) 1.5 - pvalor 0.07, OR 3.5 - pvalor 0.036, OR 2.4 - pvalor 0.08), DG (OR 2.3 - pvalor 0.006; OR 5.7 - Pvalor 0.015, OR 3.9 - pvalor 0.018) and DF (OR 1.6 -value 0.062, OR 5.5 - pvalor 0.006). For the PFP endpoint, the univariate analysis was statistically significant for NTFII (pvalor 0.009) and previous PFP (pvalor < 0.001) confirmed by the multivariate analysis (OR 24.6 - pvalor 0.009; OR 0.3 - pvalor < 0.001). The functional scales of DG (pvalor < 0.001) and CNG (pvalor < 0.001) with statistically significant results for the correlation between the outcomes. Significant clinical signs of swallowing corresponded in 44.4% oral and oral preparatory phase and 66.6% pharyngeal phase. Conclusions: The significant prognostic factors related to the functional deficits found in this study were tumor size, NFT II presence and resection type in all the outcomes studied. Functional deficits of peripheral facial paralysis were correlated with oral and pharyngeal deglutition deficits and functional disability