Definition and characteristics of climate-adaptive cities: a systematic review.

BACKGROUND: Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning. METHODS: This systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities. RESULTS: Out of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities. CONCLUSION: A climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.

Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome.

Epidermoid cysts constitute less than 1% of intracranial tumors with the majority of them involving cerebellopontine angle (CPA). Although several mechanisms for cranial nerve dysfunction due to these tumors have been proposed, no direct evaluation for hyper- or hypoactive dysfunction has been done. In this case series, pathophysiology of cranial nerve dysfunction in CPA epidermoid cysts was evaluated with special attention to a new mechanism of capsule strangulation caused by stratified tumor capsule. Twenty-two cases with epidermoid cysts of CPA micro-neurosurgically treated in our departments since 2005 were reviewed. Clinical status of the patients before the surgery and post-operative functional outcome were recorded. Available data from the English literature were summarized for comparison. Mass reduction of cyst contents in most cases was usually associated with prompt and marked improvement of the symptoms suggesting neuroapraxia caused by compression of the tumor content and/or mild ischemia. Among them, two cases showed strangulation of the affected nerves by the tumor capsule whose preoperative dysfunction did not improve after surgery in spite of meticulous microsurgical removal of the lesion. Involved facial and abducent nerves in these two cases showed distortion of nerve axis and nerve atrophy distal to the strangulation site. We report the first direct evidence of etiology of cranial nerve dysfunction caused by cerebellopontine angle epidermoid tumors. Young age and rapidly progressive neurological deficit might be the characteristics for strangulation of the affected nerves by the cyst capsule. Even though the number of cases might be limited, immediate decompression and release of the strangulating band might be urged in such patients to prevent irreversible deficits.

Neuroepithelial cyst of the fourth ventricle.

PURPOSE: Neuroepithelial cyst is considered an unusual differential diagnosis for cysts in the posterior fossa. Here, we present a paediatric case with such a pathology and review the pertinent literature. METHODS: A 12-year old girl with headache, vertigo and disturbed gait was diagnosed with a cystic lesion in the fourth ventricle after brain MRI study. She was operated with the pre-operative diagnosis of arachnoid cyst. RESULTS: A transparent, colourless cyst was observed intra-operatively. As frozen sections were consistent with endodermal cyst, total removal of the cyst was attempted. Definite histopathological studies and immunohistochemistry stains were in favour of neuroepithelial cyst. No regrowth of the cyst or recurrence of the symptoms was observed in her 2-year follow-up. CONCLUSIONS: As neuroepithelial cyst is rarely encountered in the posterior fossa, the clinical, radiological and pathological characteristics of our case along with similar cases in the literature were reviewed and discussed.

Effect of magnesium on functional outcome and paraclinical parameters of patients undergoing supratentorial craniotomy for brain tumors: a randomized controlled trial.

BACKGROUND: Several studies have demonstrated that magnesium (Mg) plays an important role in the prevention and treatment of central nervous system (CNS) insults. In this study, we tested the effect of intravenous magnesium sulfate (MgSO4) on the outcome of patients with brain tumors who underwent craniotomy. The outcome was defined clinically as the Barthel index score and paraclinically as blood levels of NSE (neuron-specific enloase) and S100Β protein. METHODS: Sixty patients were randomly divided into two groups of 30 patients: the treatment and control groups. In the treatment group, 5 g of MgSO4 in normal saline was infused in 6 h 2 days before surgery, and the same dosage was repeated the day before and during surgery. The control group received placebo. Serum S100Β and NSE concentrations were measured at baseline before administration of magnesium, before surgery, and on the 2nd postoperative day. The Barthel index score was evaluated and registered before surgery, 3, and 6 months after the operation. RESULTS: The study results showed a significant change in S100Β protein levels before and after surgery (p < 0.05), but we could not find similar results for NSE protein and the Barthel index score. There was a correlation between NSE protein and the Barthel index. CONCLUSIONS: The results of this study revealed that administration of intravenous MgSO4 before and during surgery is safe and effective in reducing S100B protein levels in patients undergoing supratentorial craniotomy for brain tumors. Further studies to elucidate the pathophysiology of brain injuries and role of magnesium are warranted.

Bibliometric overview of the Tehran Lipid and Glucose Study (TLGS) publications from 2000 to 2022.

Aim: The present study was conducted to analyze the publications of the Tehran Lipid and Glucose Study (TLGS) and assess its scientific productions during the last 23 years. Methods: The required data were retrieved from the Scopus database. The advanced search was chosen, and the search query included terms related to the TLGS. Search and retrieval of data were conducted on August 30, 2022. Bibliometric indicators have been used at three levels in this research including the level of documents, journals, and authors. Also, the knowledge structure of this set was analyzed at the level of social structure and the level of conceptual structure. Data analysis and visualizations was performed using Bibliometrix and VOSviewer software. Results: A total of 870 documents related to the TLGS have been indexed in the Scopus from 2000 to 2022, and 1148 authors have participated in the relevant studies. 66.4% of the TLGS documents were published in journals with Q1 subject area quartiles. There was an annual growth rate of 20% and average citations per document of 16.5. There was a co-authorship per document of 5.6 and an international co-authorship of 8.7%. According to the co-occurrence network for keywords, the most common areas in the TLGS published documents were nutrition, epidemiologic issues, cardiometabolic-related biomarkers, diabetes, hypertension, lifestyle variables and genetic studies. Conclusion: Over the past 23 years, the TLGS has successfully addressed a wide range of inquiries pertaining to cardiometabolic and nutritional issues in Iran. The remarkable achievements of the TLGS act as a catalyst, advocating for the planning and implementation of additional cohort studies that specifically focus on non-communicable diseases within the Iranian population.

The effectiveness of digital storytelling in teaching medical information searching.

BACKGROUND: Novel technologies development has created a new path for education. Digital storytelling (DST) is one of the educational approaches used in universities and scientific centers. We aimed to investigate the effect of DST on Scientific Information Search (SIS) and Information Seeking Anxiety (ISA) in students. MATERIALS AND METHODS: This mixed-method study utilized the pre-test-post-test method containing test and control groups. We used the simple random sampling method (available) and used the formula to determine the sample size. Forty-two people participated in the study. A researcher-made questionnaire was used to collect SIS data and standard questionnaire for ISA data. The teaching approaches were accomplished using DST and the conventional methods in test and control groups, respectively. Using SPSS v. 22, we did paired-sample T-test and independent sample T-test to compare the mean score in before and after intervention in each group. Also Analysis of Covariancetest was used for considering post-test result as dependent variable, groups as independent variables and pre-test score as covariate. RESULTS: The results showed significant changes in mean score between the post-test and pre-test of both questionnaire in both groups. Also, in the post-test, compared to the control group, the experimental group obtained higher scores for SIS, which was statistically significant, and obtained lower scores for ISA, but it was not statistically significant. CONCLUSIONS: It can be concluded that the DST method has a positive impact on learning and reducing ISA compared to the conventional ones, and students' interest and participation in learning have increased using DST method.

Procedural and Clinical Outcome Analysis of Monoplane versus Biplane Angiography Suites in Stroke Thrombectomies.

BACKGROUND: Thrombectomy is now the standard of care in the treatment of acute ischemic stroke caused by emergent large vessel occlusion. Therefore thrombectomy services have expanded from Comprehensive Stroke Centers to Thrombectomy-Capable Stroke Centers. Stroke interventions at these sites are performed in both biplane and monoplane angiography suites. It has been hypothesized that differences in these systems may affect time to successful reperfusion, with a potentially significant effect on neurologic outcomes. With an increase in TSCs, this study aims to evaluate the safety and efficacy of monoplane thrombectomy versus biplane thrombectomy. METHODS: Patients who presented with isolated proximal middle cerebral artery M1 occlusions and underwent endovascular thrombectomy from March 2015 to August 2018 at 5 different centers within a single health system were included. Thrombectomy was performed by the same group of experienced neurointerventionalists. The primary endpoint was functional outcome as measured by the modified Rankin scale at 90 days. Secondary endpoints included recanalization grade as measured by the Thrombolysis in Cerebral Infarction score, time to final reperfusion, and incidence of hemorrhagic conversion. RESULTS: A total of 197 patients were included in this study. Of them, 80.7% underwent thrombectomy on biplane systems. Time to final reperfusion was 10.2 minutes longer in the monoplane group but was not statistically significant (P = 0.252). There was no significant difference in the rates of favorable reperfusion (P = 0.755), hemorrhagic conversion (P = 0.580), or functional outcome at 90 days (favorable modified Rankin Scale 0-2, P = 0.210; favorable modified Rankin Scale 0-3, P = 0.697). CONCLUSION: Despite perceived advantages of biplane systems in reducing procedural time, our study demonstrates no significant differences between systems. These data support the safety and efficacy of performing thrombectomy on monoplane systems and may also carry implications for reducing patient transfer times and potentially increasing thrombectomy access to areas of the world where biplane suites may not be available. The next step would be a prospective randomized trial comparing both systems in different settings.

Mapping Global Research in Emergency Medicine; a Bibliometric Analysis of Documents Indexed in the Web of Science Database.

Introduction: Emergency medicine is a relatively new and rapidly growing specialty, and its research monitoring is important for future policies. This study aimed to analyze the published literature related to emergency medicine, to create a documented research perspective for this field. Methods: This research is a bibliometric study that analyzes the research outputs of the subject area of emergency medicine indexed in the Web of Science database from the beginning to 2023. VOSviewer software was used to visualize and predict the trends in research on the topic. Results: The findings showed that the University of California, The Journal of Neurotrauma and Brain Injury, Elsevier, and the USA were the most prolific units in the cycle of scientific productions in the field of emergency medicine. Results showed that most scientific productions in this field fall into 6 clusters: psychological impressions, injuries caused by traumatic events and the effects of traumas on children, pathophysiology and nervous system issues and related diseases, complications of traumatic events and injuries, biomechanics and complications caused by sports injuries, and consciousness. Conclusion: In addition to interventions and clinical complications, research in the field of emergency medicine has also focused on psychological structures. So, based on various measurement indicators, the subjects of this field have been the focus of researchers' attention.

COVID-19 in Homelessness: A Worldwide Scoping Review on Vulnerabilities, Risks, and Risk Management.

Homeless individuals are at greater risk of death due to social inequalities during Covid-19 pandemic. Strategies taken for general population to prevent the spread of Covid-19, such as social distance, staying at home, and observing personal hygiene are not possible for this group of people. This is a scoping review on articles published and other credible resources published analyze studies done on homeless people during the COVID-19 pandemic. In this scoping review, for the first time, we studied published articles on the situation of the homeless during the Covid-19 epidemic and by extracting and categorizing vulnerabilities, risks, as well as risk management plans, Finally we presented, useful guidance for organizations providing health and social services during the spread of diseases.

Intradural Extramedullary Cavernous Malformation of the Spinal Cord with Hemorrhagic Transformation and Rapid Expansion.

Intradural extramedullary cavernous malformations in the spinal cord are rarely occurring vascular lesions. Mostly they are clinically silent unless the hemorrhagic transformation causes subarachnoid hemorrhage or neurologic deficits. We report the case of a 51-year-old man who developed a headache and weakness of the lower limb. Spinal cord magnetic resonance imaging revealed that the cause of his symptoms was a spinal intradural and extramedullary cavernous malformation with hemorrhagic transformation causing subarachnoid hemorrhage and compression of the thoracic spinal cord. Surgical decompression of the spinal cord followed by the resection of the lesion resulted in significant neurological improvement. Early diagnosis and early surgical extirpation of the lesion should be done to prevent recurrent hemorrhagic transformation and development of neurological symptoms.

Retrosigmoid transhorizontal fissure approach to lateral pontine cavernous malformation: comparison to transpetrosal presigmoid retrolabyrinthine approach.

OBJECTIVE: The retrosigmoid (RS) approach is a classic route used to access deep-seated brainstem cavernous malformation (CM). The angle of access is limited, so alternatives such as the transpetrosal presigmoid retrolabyrinthine (TPPR) approach have been used to overcome this limitation. Here, the authors evaluated a modification to the RS approach, horizontal fissure dissection by using the RS transhorizontal (RSTH) approach. METHODS: Relevant clinical parameters were evaluated in 9 patients who underwent resection of lateral pontine CM. Cadaveric dissection was performed to compare the TPPR approach and the RSTH approach. RESULTS: Five patients underwent the TPPR approach, and 4 underwent the RSTH approach. Dissection of the horizontal fissure allowed for access to the infratrigeminal safe entry zone, with a direct trajectory to the middle cerebellar peduncle similar to that used in TPPR exposure. Operative time was longer in the TPPR group. All patients had a modified Rankin Scale score ≤ 2 at the last follow-up. Cadaveric dissection confirmed increased anteroposterior working angle and middle cerebellar peduncle exposure with the addition of horizontal fissure dissection. CONCLUSIONS: The RSTH approach leads to a direct lateral path to lateral pontine CM, with similar efficacy and shorter operative time compared with more extensive skull base exposure. The RSTH approach could be considered a valid alternative for resection of selected pontine CM.

Surgical Trapping of a Large Complex Middle Cerebral Artery Aneurysm With Double-Barrel Bypass: 3-Dimensional Operative Video.

Large middle cerebral artery (MCA) bifurcation aneurysms are known vascular lesions that are usually symptomatic but often difficult to treat (whether with open or endovascular techniques), especially when the M2 branches originate from the aneurysm dome.1-7 The challenge lies in securing the aneurysm while fully maintaining the flow in the vessels arising from the dome. Standard microsurgical clipping or endovascular techniques are not feasible in perfectly treating these aneurysms. Revascularization of the MCA branches with bypass and trapping of the aneurysm is often necessary. Here, we present a case of a large complex partially thrombosed right MCA bifurcation aneurysm with both the superior and the inferior divisions arising from the dome. The patient initially presented with a right MCA stroke and left hemiparesis. Using radial artery as an interposition graft, 2 bypasses-internal maxillary artery to the inferior division and superficial temporal artery to the superior division-were performed. The aneurysm was trapped and decompressed by placing clips at the M1 terminus and the M2 origins. Intraoperative angiography and postoperative NOVA (VasSol Inc.) magnetic resonance angiography (MRA) confirmed patency and excellent flow in the bypass grafts. The patient's postoperative course was uncomplicated, and at 2-mo follow-up, had significant improvement of her hemiparesis. The patient provided informed consent for the procedure.

Cerebral Bypass for Aneurysms in the Era of Flow Diversion: Single-Surgeon Case Series.

BACKGROUND: With recent advances in endovascular treatments of brain aneurysms such as flow diverters, the role of cerebral revascularization needs to be re-evaluated. OBJECTIVE: To evaluate the contemporary indications and outcomes of cerebral revascularization for brain aneurysms. METHODS: A retrospective evaluation of a prospectively maintained database was performed to review clinical and imaging data of all the patients who underwent cerebral revascularization for brain aneurysms over the past 10 yr. RESULTS: Among 174 cerebral revascularizations, 40 (in 36 patients) were done for the treatment of aneurysms. In total, 9 patients underwent combined endovascular treatment and surgical revascularization. Immediate aneurysm occlusion was achieved in 30 patients (83.3%). Immediate postoperative bypass patency was confirmed in 33 patients (92%). Postoperative neurological deficit was observed in 4 patients (11.1%). There were 2 mortalities in the postoperative period. Aneurysm total occlusion rate was 91% at 1 yr. Thirty patients had 1 yr clinical and radiological follow-up. Clinical evaluations showed modified Rankin Scale 2 or less in 25 patients at 1 yr. Bypass patency was confirmed in 27 (90%). Patients with fair/poor outcome were all in the subarachnoid hemorrhage group. Twenty-one patients had follow-up studies for 3 yr or beyond with no evidence of stroke or aneurysm recurrence. CONCLUSION: Our results support that cerebral revascularization can be regarded as a viable and durable treatment option for these challenging aneurysms with acceptable morbidity. Cerebral bypass should be offered in selected cases where standard endovascular or surgical treatment is not efficacious or curative.

Contralateral Transfalcine Approach to Deep Parasagittal Arteriovenous Malformations-Technical Note.

BACKGROUND: Resection of deep medial frontal and parietal arteriovenous malformations (AVMs) is often challenging due to a tangential angle of attack and deep, narrow working corridor. Adequate visualization of the AVM and its feeding arteries without brain retraction is of particular importance when operating in or near eloquent cortical areas, where brain manipulation could inadvertently result in neurologic deficits. The aim of this paper is to provide a step-by-step description of surgical approach and report our experience with the contralateral transfalcine approach for resection of deep-seated parasagittal AVMs. METHODS: Contralateral transfalcine resection of deep frontal, parietal, and cingulate gyrus AVMs was performed with the unaffected hemisphere positioned in a gravity-dependent manner in 5 cases. Surgical procedures were video documented, and an illustrative case is presented. All 5 patients had a modified Rankin Scale score of 0 or 1 at the last follow-up. RESULTS: Complete resection of the AVM was achieved in all 5 cases. No permanent major neurologic deficit was observed postoperatively. This approach allowed a superior visualization of arterial feeders, the parenchymal side of the AVM, and an early control of small parenchymal feeders while minimizing retraction of the brain. CONCLUSIONS: The contralateral transfalcine approach is a useful technique in the cerebrovascular surgeon's armamentarium for management of deep-seated medial frontal, parietal, and cingulate gyrus AVMs in or around eloquent brain areas, allowing to minimize normal brain retraction and avoid associated neurologic deficits.

Surgical Approaches to Basilar Apex Aneurysms: An Illustrative Review.

Surgical management of basilar apex aneurysms remains one of the most challenging areas in neurovascular surgery. Technical demands of treating these aneurysms have inspired several generations of neurosurgeons to push the limitations of technical achievement. Advances in neuroanesthesia, cerebral protection paradigms, and critical care management have enhanced surgical outcomes of these lesions. Several approaches have been described to reach these lesions from anterolateral or lateral corridors. Each surgical approach has its own advantages and limitations and should be chosen for each patient according to the aneurysm's position, projection, parent arteries, and perforators. In this review, we will discuss pros and cons of the common approaches to these aneurysms with description of the important steps of each surgical procedure.

Sphenoid Wing Meningioma with Surgical Revascularization of an Injured Anterior Temporal Artery.

A 79-year-old woman presented to the emergency department following multiple falls in the previous week. Her past medical history was unremarkable except for chronic obstructive pulmonary disease. She was neurologically intact on arrival with normal laboratory data. Brain imaging revealed a right-sided sphenoid wing meningioma with considerable edema around it. Owing to her cognitive decline and recent symptoms, it was decided to proceed with surgical resection of the lesion. Considering her age and underlying disease, we planned to avoid probable complications of an aggressive resection. She underwent preoperative transarterial embolization with particles. In the supine position, a right pterional craniotomy with orbital extension was performed followed by tumor resection under microscopic magnification. One of the branches of the middle cerebral artery was engulfed by the tumor and could not be separated; therefore, the artery was cut to resect the tumor and then mobilized and reanastomosed under microscope. Doppler probe confirmed patency of the anastomosis. The patient recovered well from the surgery, experienced an uneventful hospital stay, and was discharged on postoperative day 10 after completely controlling her chronic obstructive pulmonary disease. Postoperative imaging did not show any signs of infarction, and the revascularized artery was patent on postoperative computed tomography angiography (Video 1).

Pterygo-Maxillary Fissure as a Landmark for Localization of Internal Maxillary Artery for Use in Extracranial-Intracranial Bypass.

BACKGROUND: Internal maxillary artery (IMax) is a relatively new donor vessel used in the extracranial-intracranial bypass surgery. However, unfamiliarity and relatively elaborate techniques of its harvest precluded its widespread use. OBJECTIVE: To present a simplified technique of IMax harvest based on constant anatomical landmarks without the need of extensive skull-base drilling while providing adequate space for proximal anastomosis. METHODS: Cadaveric dissection on 4 cadaveric heads (8 sides) was performed. Zygomatic osteotomy was performed and temporal muscle was dissected off the zygomatic process of the frontal bone and the frontal process of the zygomatic bone and reflected inferiorly into the bony gap created by the zygomatic osteotomy. Posterior wall of the maxilla (PWoM) was palpated. Following PWoM inferiorly leads to pterygo-maxillary fissure (PMF), which is a constant landmark IMax passes through. RESULTS: IMax was localized following this technique before its entrance into PMF in every specimen. Proximal dissection was carried on to the exposed adequate length of the vessel. Depending on the relationship with the lateral pterygoid muscle, this might need to be incised to allow for identification of the IMax. After its transection, proximal stump is mobilized superiorly into the surgical field. Clinical application of this technique was demonstrated on an aneurysm case. CONCLUSION: Using the palpation of the PWoM as a landmark for localization of PMF facilitates harvesting of IMax without need for extensive skull-base drilling and shortens the time of the surgery.

The effect of adenosine in inducing cardiac arrest for endovascular treatment of paediatric high-flow brain and spinal vascular malformation.

INTRODUCTION: Endovascular treatment of high-flow vascular lesions with onyx may be very dangerous due to premature occlusion of the vein resulting from high flow-induced migration of this embolic substance without occlusion of the feeding vessels and the nidus. It is also dangerous because of the risk of occlusion of the normal vessels around the lesion. Inducing temporary cardiac arrest using adenosine may be helpful in limiting and minimizing these risks. However anaesthetic management of this procedure in children suffering from high-flow vascular lesions is difficult and challenging. METHODS: We report three paediatric patients with high-flow cerebrospinal vascular lesions that underwent endovascular treatment under general anaesthesia and temporary cardiac arrest with adenosine. Adenosine was administered in escalating doses to induce a few seconds of cardiac standstill and the onyx injection was synchronized with the onset of adenosine-induced cardiac standstill, the fistula being occluded by onyx. RESULTS: There were no complications in peri-procedural treatment in all three cases. Post-embolization angiography revealed complete obliteration of the lesion, and the patients' neurological status progressively improved at follow-up. CONCLUSION: Adenosine-induced temporary cardiac standstill was successfully used to facilitate safe and controlled endovascular onyx embolization of high-flow central nervous system vascular lesions.

Effect of metal chelating agents on pentylenetetrazole-induced seizure threshold in cholestatic mice.

Zinc has been proven to be anticonvulsant in several studies which indicate that diphenylthiocarbazone (dithizone) and diethyldithiocarbamate (DEDTC), zinc chelating agents, enhance seizure activities. There is also evidence that nitric oxide (NO) generators increase zinc concentration in the brain. On the other hand, the increased level of NO in the nervous system and the consequently increased seizure threshold in cholestatic mice have been well studied. Thus, it could be hypothesized that one of the reasons for the increased seizure threshold in cholestasis is partly the enhanced endogenous zinc concentration, at least in part, due to the overproduction of NO. In this study, we examined the hypothesis that zinc chelating agents might decrease seizure activity to its pre-cholestatic level in bile duct-ligated (BDL) mice. Mice were intra-peritoneally injected with dithizone and diethyldithiocarbamate (DEDTC) before the induction of seizure by pentylenetetrazole (PTZ) and then the seizure activity was recorded. Dose response (dithizone: 5, 30, 100 and 200mg/kg; DEDTC: 25, 50 and 100mg/kg) and time course (only for dithizone: 15, 30, 60 and 120 min) studies were performed first. Then, the effects of cholestasis, with and without dithizone injection, on seizure activity were assessed. Proconvulsant effect of dithizone and DEDTC was proved to be dose dependent although time interval between dithizone and PTZ injections did not play any significant role in the seizure activity. Cholestasis decreased seizure activity and increased lag phase before seizure and both effects were decreased by dithizone injection. It is elicited that zinc may mediate the cholestasis-induced decrement in seizure activity.

Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery.

OBJECTIVE: The paper aims to define the parameters available before surgery which could predict immediate facial nerve function after excision of a vestibular schwannoma (VS). METHODS: Ninety-nine patients with VS operated consecutively by a single surgeon using an identical surgical technique have been evaluated retrospectively. Data were collected regarding patients' sex, age at onset of symptoms and at surgery, initial symptoms, neurological status at presentation, early post-operative neurological status and complications. The main radiological parameters included in the study were tumour extension pattern, diameters, shape, and volume, as well as extent of bony changes of the internal auditory canal. RESULTS: As the tumour stage and volume increase, facial nerve function is worse after surgery (p < 0.001 and p < 0.05, respectively). Concomitantly, larger extra-meatal tumour diameters in three dimensions (sagittal, coronal and axial) led to worse function (p < 0.01). Anterior and/or caudal tumour extension (p = 0.001 and p = 0.004, respectively) had more significant correlation than posterior and/or cranial extension (p = 0.022 and p = 0.353, respectively). Polycyclic VS had the worst prognosis, followed by the tumours with oval shape. The extent of intra-meatal tumour growth does not correlate with immediate facial nerve outcome. The different angles, lengths and diameters of the internal auditory channel showed no significant correlation with facial nerve outcome. Patients with headache as an initial symptom and those with gait instability and/or pre-operative poor facial nerve function had significantly worse immediate facial nerve outcome. CONCLUSION: Our data suggests that the analysis of the radiological and neurological patient data prior to surgery could give reliable clues regarding the immediate post-operative facial nerve function.