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J Neurol Surg B Skull Base 2018; 79(06): 528-532
DOI: 10.1055/s-0038-1635256
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Revision Surgery for Vestibular Schwannomas

Kevin A. Peng
1   House Clinic, Los Angeles, California, United States
,
Brian S. Chen
3   Ear Nose and Throat Surgery Clinic, William Beaumont Army Medical Center, El Paso, Texas, United States
,
Mark B. Lorenz
2   Alaska Center for Ear, Nose and Throat, Anchorage, Alaska, United States
,
Gregory P. Lekovic
1   House Clinic, Los Angeles, California, United States
,
Marc S. Schwartz
1   House Clinic, Los Angeles, California, United States
,
William H. Slattery
1   House Clinic, Los Angeles, California, United States
,
Eric P. Wilkinson
1   House Clinic, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

05 October 2017

21 February 2018

Publication Date:
09 April 2018 (online)

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Abstract

Objectives To describe clinical outcomes of patients undergoing revision surgery for vestibular schwannomas.

Design Retrospective case series.

Setting Tertiary private neurotologic practice.

Participants Patients who underwent revision surgeries for recurrent/residual vestibular schwannomas between 1985 and 2015.

Main Outcome Measures Degree of resection, facial nerve function, cerebrospinal fluid (CSF) leak.

Results A total of 234 patients underwent 250 revision surgeries for recurrent/residual vestibular schwannomas. Of these, 86 carried a diagnosis of neurofibromatosis type 2 (NF2). The mean number of prior surgeries was 1.26, and 197 (85%) prior surgeries had been performed elsewhere. The average age at surgery was 43. The most common approach employed at the time of revision surgery was translabyrinthine (87%), followed by transcochlear (6%), middle fossa (5%), and retrosigmoid (2%). Gross total resection was achieved in 212 revision surgeries (85%). Preoperative House–Brackmann facial nerve function was similar in non-NF2 and NF2 groups (mean: 2.7). Mean postoperative facial nerve function at last follow-up was 3.8 in the non-NF2 group and 3.9 in the NF2 group. History of radiation and the extent of resection were not associated with differences in facial nerve function preoperatively or postoperatively. CSF leaks occurred after 21 surgeries (8%), and six (2%) patients required reoperation.

Conclusions This is the largest series of revision surgery for vestibular schwannomas to date. Our preferred approach is the translabyrinthine craniotomy, which can be readily modified to include the transcochlear approach for improved access. CSF leak rate slightly exceeds that of primary surgery, and gross total resection is achievable in the vast majority of patients.

Keywords

vestibular schwannoma - acoustic neuroma - translabyrinthine approach - retrosigmoid approach - middle fossa approach - microsurgery
 

  • References

  • 1 Stangerup SE, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol 2006; 27 (04) 547-552
    CrossrefPubMedGoogle Scholar
  • 2 Yoshimoto Y. Systematic review of the natural history of vestibular schwannoma. J Neurosurg 2005; 103 (01) 59-63
    CrossrefPubMedGoogle Scholar
  • 3 Rutherford SA, King AT. Vestibular schwannoma management: what is the ‘best’ option?. Br J Neurosurg 2005; 19 (04) 309-316
    CrossrefPubMedGoogle Scholar
  • 4 Lanman TH, Brackmann DE, Hitselberger WE, Subin B. Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. J Neurosurg 1999; 90 (04) 617-623
    CrossrefPubMedGoogle Scholar
  • 5 Friedman RA, Kesser B, Brackmann DE, Fisher LM, Slattery WH, Hitselberger WE. Long-term hearing preservation after middle fossa removal of vestibular schwannoma. Otolaryngol Head Neck Surg 2003; 129 (06) 660-665
    CrossrefPubMedGoogle Scholar
  • 6 Irving RM, Jackler RK, Pitts LH. Hearing preservation in patients undergoing vestibular schwannoma surgery: comparison of middle fossa and retrosigmoid approaches. J Neurosurg 1998; 88 (05) 840-845
    CrossrefPubMedGoogle Scholar
  • 7 Colletti V, Fiorino F. Middle fossa versus retrosigmoid-transmeatal approach in vestibular schwannoma surgery: a prospective study. Otol Neurotol 2003; 24 (06) 927-934
    CrossrefPubMedGoogle Scholar
  • 8 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997; 40 (01) 11-21 , discussion 21–23
    PubMedGoogle Scholar
  • 9 Pollock BE, Lunsford LD, Flickinger JC, Clyde BL, Kondziolka D. Vestibular schwannoma management. Part I. Failed microsurgery and the role of delayed stereotactic radiosurgery. J Neurosurg 1998; 89 (06) 944-948
    CrossrefPubMedGoogle Scholar
  • 10 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
    CrossrefPubMedGoogle Scholar
  • 11 Sanna M, Falcioni M, Taibah A, De Donato G, Russo A, Piccirillo E. Treatment of residual vestibular schwannoma. Otol Neurotol 2002; 23 (06) 980-987
    CrossrefPubMedGoogle Scholar
  • 12 Sughrue ME, Kaur R, Rutkowski MJ. , et al. Extent of resection and the long-term durability of vestibular schwannoma surgery. J Neurosurg 2011; 114 (05) 1218-1223
    CrossrefPubMedGoogle Scholar
  • 13 Tang S, Griffin AS, Waksal JA. , et al. Surveillance after resection of vestibular schwannoma: measurement techniques and predictors of growth. Otol Neurotol 2014; 35 (07) 1271-1276
    PubMedGoogle Scholar
  • 14 Freeman SR, Ramsden RT, Saeed SR. , et al. Revision surgery for residual or recurrent vestibular schwannoma. Otol Neurotol 2007; 28 (08) 1076-1082
    CrossrefPubMedGoogle Scholar
  • 15 Brackmann DE, Cullen RD, Fisher LM. Facial nerve function after translabyrinthine vestibular schwannoma surgery. Otolaryngol Head Neck Surg 2007; 136 (05) 773-777
    CrossrefPubMedGoogle Scholar
  • 16 Mamikoglu B, Wiet RJ, Esquivel CR. Translabyrinthine approach for the management of large and giant vestibular schwannomas. Otol Neurotol 2002; 23 (02) 224-227
    CrossrefPubMedGoogle Scholar
  • 17 Falcioni M, Mulder JJ, Taibah A, De Donato G, Sanna M. No cerebrospinal fluid leaks in translabyrinthine vestibular schwannoma removal: reappraisal of 200 consecutive patients. Am J Otol 1999; 20 (05) 660-666
    PubMedGoogle Scholar
  • 18 Zhang Z, Wang Z, Huang Q, Yang J, Wu H. Removal of large or giant sporadic vestibular schwannomas via translabyrinthine approach: a report of 115 cases. ORL J Otorhinolaryngol Relat Spec 2012; 74 (05) 271-277
    CrossrefPubMedGoogle Scholar
  • 19 Merkus P, Taibah A, Sequino G, Sanna M. Less than 1% cerebrospinal fluid leakage in 1,803 translabyrinthine vestibular schwannoma surgery cases. Otol Neurotol 2010; 31 (02) 276-283
    CrossrefPubMedGoogle Scholar
  • 20 Copeland WR, Mallory GW, Neff BA, Driscoll CL, Link MJ. Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?. J Neurosurg 2015; 122 (02) 312-316
    CrossrefPubMedGoogle Scholar
  • 21 Fishman AJ, Marrinan MS, Golfinos JG, Cohen NL, Roland Jr JT. Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery. Laryngoscope 2004; 114 (03) 501-505
    CrossrefPubMedGoogle Scholar
  • 22 Springborg JB, Fugleholm K, Poulsgaard L, Cayé-Thomasen P, Thomsen J, Stangerup SE. Outcome after translabyrinthine surgery for vestibular schwannomas: report on 1244 patients. J Neurol Surg B Skull Base 2012; 73 (03) 168-174
    PubMedGoogle Scholar