Treatment of Large and Giant Residual and Recurrent Vestibular Schwannomas

ABSTRACT

This report is a retrospective analysis of the surgical outcome of 15 patients (8 females, 7 males; mean age, 37.8 years) with residual or recurrent vestibular schwannomas operated on between 1987 and 2005. These 15 patients were part of a larger series of 252 consecutive vestibular schwannoma excisions. Tumors were classified as large (10) when their diameter exceeded 3.5 cm and giant (5) when their diameter exceeded 4.5 cm. All patients had previously undergone surgery. Hearing was lost in all cases, 8 had complete facial nerve palsy, 6 had trigeminal nerve deficits, 5 had cranial nerve IX and X palsy, and 10 had ataxic gait. Twelve patients had hydrocephalus. The tumors were reoperated through the retrosigmoid-transmeatal approach. The mean postoperative follow-up was 4.9 years. Complete resection was achieved in all patients. The facial nerve was preserved in 6 of the 7 patients with preoperative facial function. Transient worsening of bulbar cranial nerves palsy occurred in 2 cases. Cerebrospinal fluid leakage occurred in 3 patients. There were no deaths, and the tumors were histologically benign. Surgical removal is the only treatment for these lesions. Total resection associated with a low morbidity rate is possible. Preservation of the facial nerve is difficult due to severe scar tissue.

KEYWORDS

Vestibular schwannomas - residual acoustic neurinomas - recurrent acoustic neurinomas - giant acoustic neurinoma - surgery

REFERENCES

• 1 Beatty C W, Ebersold M J, Harner S G. Residual and recurrent acoustic neuromas.  Laryngoscope. 1987;  97 1168-1171
• 2 Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas.  Surg Neurol. 2003;  59 283-291
• 3 Roberson Jr J B, Brackmann D E, Hitselberger W E. Acoustic neuroma recurrence after suboccipital resection: management with translabyrinthine resection.  Am J Otol. 1996;  17 307-311
• 4 Sanna M, Falcioni M, Taibah A, De Donato G, Russo A, Piccirillo E. Treatment of residual schwannoma.  Otol Neurotol. 2002;  23 980-987
• 5 Shea 3rd J J, Hitselberger W E, Benecke Jr J E, Brackmann D E. Recurrence rate of partially resected acoustic tumors.  Am J Otol. 1985;(Suppl);  107-109
• 6 Matthies C, Samii M. Vestibular schwannomas and auditory function: options in large T3 and T4 tumors?.  Neurochirurgie. 2002;  48 461-470
• 7 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 11-23
• 8 Shelton C. Unilateral acoustic tumors: how often do they recur after translabyrinthine removal?.  Laryngoscope. 1995;  105 958-966
• 9 El-Kashlan H K, Zeitoun H, Arts H A, Hoff J T, Telian S A. Recurrence of acoustic neuroma after incomplete resection.  Am J Otol. 2000;  21 389-392
• 10 Gamache F, Patterson R. Growth rates for residual and recurrent acoustic neuroma. In: Tos M, Thomsen J Acoustic Neuroma. Amsterdam, The Netherlands; Kugler 1992: 705-707
• 11 Pace-Balzan A, Lye R H, Ramsden R T, Chandler C, Gillespie J E, Dutton J M. Growth characteristics of acoustic neuromas with particular reference to the fate of capsule fragments remaining after tumor removal: implications for patient management. In: Tos M, Thomsen J Acoustic Neuroma. Amsterdam, The Netherlands; Kugler 1992: 701-703
• 12 Sakaki S, Nakagawa K, Hatakeyama T, Murakami Y, Ohue S, Matsuoka K. Recurrence after incompletely resected acousticus neurinomas.  Med J Osaka Univ. 1991;  40(1-4) 59-66
• 13 Bloch D C, Oghalai J S, Jackler R K, Osofsky M, Pitts L H. The fate of the tumor remnant after less-than-complete acoustic neuroma resection.  Otolaryngol Head Neck Surg. 2004;  130 104-112
• 14 Gormley W B, Sekhar L N, Wright D C, Kamerer D, Schessel D. Acoustic neuromas: results of current surgical management.  Neurosurgery. 1997;  41 50-60
• 15 Lanman T H, Brackmann D E, Hitselberger W E, Subin B. Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach.  J Neurosurg. 1999;  90 617-623
• 16 Ramina R, Maniglia J J, Meneses M S et al.. Acoustic neurinomas. Diagnosis and treatment.  Arq Neuropsiquiatr. 1997;  55(3A) 393-402
• 17 Thomassin J M, Pellet W, Epron J P, Braccini F, Roche P H. Recurrent acoustic neurinoma after complete surgical resection [in French].  Ann Otolaryngol Chir Cervicofac. 2001;  118 3-10
• 18 Unger F, Walch C, Papaefthymiou G, Feichtinger K, Trummer M, Pendl G. Radiosurgery of residual and recurrent vestibular schwannomas.  Acta Neurochir (Wien). 2002;  144 671-677
• 19 Kondziolka D, Lunsford L D, Flickinger J C. Acoustic tumors: operation versus radiation-making sense of opposing viewpoints. Part II Acoustic neuromas: sorting out management options.  Clin Neurosurg. 2003;  50 313-328
• 20 Ito K, Shin M, Matsuzaki M, Sugasawa K, Sasaki T. Risk factors for neurological complications after acoustic neurinoma radiosurgery: refinement from further experiences.  Int J Radiat Oncol Biol Phys. 2000;  48 75-80
• 21 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147