What Is the Best Tumor Size to Achieve Optimal Functional Results in Vestibular Schwannoma Surgery?

Mislav Gjuric; Milan Rudic

doi:10.1055/s-0028-1086056

Skull Base, Table of Contents

Skull Base 2008; 18(5): 317-325
DOI: 10.1055/s-0028-1086056

ORIGINAL ARTICLE

What Is the Best Tumor Size to Achieve Optimal Functional Results in Vestibular Schwannoma Surgery?

Mislav Gjuric¹ , Milan Rudic²

¹Department of Otorhinolaryngology, KBC Zagreb, University of Zagreb, Zagreb, Croatia
²Department of Otorhinolaryngology, General Hospital Zadar, Zadar, Croatia

Abstract

ABSTRACT

Objectives: To analyze our own functional results to delineate a critical vestibular schwannoma size for middle cranial fossa (MCF) surgery with the best possible outcome. Study Design: Retrospective chart review. Setting: Academic tertiary referral center. Methods: Tumors were divided into intracanalicular, tumors 1 to 5, 6 to 10, and 11 to 15 mm in the cerebellopontine angle (CPA). Patients were evaluated at 2 months, 1 year, and 5 years after surgery. Results: At 1 year, House-Brackmann score of I or II was obtained in 100% of intracanalicular and in 96%, 86%, and 85% with tumors up to 5, 10, and 15 mm in the CPA, respectively. Class I hearing was postoperatively preserved in 61%, 41%, 29%, and 20%, and measurable word recognition in 67%, 51%, 35%, and 21% of patients, respectively. Conclusion: The outcome is predominantly a function of tumor size, and these changes influence MCF surgery at an earlier stage than in the translabyrinthine or retrosigmoid approach. For the facial nerve, there is a cutoff at 5-mm extracanalicular extension. Also, chances for successful hearing preservation decrease rapidly with size, and in tumors beyond 1.5 cm are below 20%. Consequently, although an expectant policy with small tumors may be reasonable in some instances, it is not so for MCF candidates.

KEYWORDS

Vestibular schwannoma - hearing preservation - tumor size - facial nerve - middle cranial fossa - long-term results

Full Text

References

REFERENCES

1 Stangerup S E, Caye-Thomasen P, Tos M, Thomsen J. The natural history of vestibular schwannoma. Otol Neurotol. 2006; 27 547-552
2 Tos M, Charabi S, Thomsen J. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol. 1998; 255 1-6
3 Sterkers J M, Morrison G A, Sterkers O, El-Dine M M. Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment. Otolaryngol Head Neck Surg. 1994; 110 146-155
4 Magnan J, Barbieri M, Mora R et al.. Retrosigmoid approach for small and medium-sized acoustic neuromas. Otol Neurotol. 2002; 23 141-145
5 Slattery W H, Brackmann D E, Hitselberger W. Middle fossa approach for hearing preservation with acoustic neuromas. Am J Otol. 1997; 18 596-601
6 Weber P C, Gantz B J. Results and complications from acoustic neuroma excision via middle cranial fossa approach. Am J Otol. 1996; 17 669-675
7 Gjuric M, Wigand M E, Wolf S R. Enlarged middle fossa vestibular schwannoma surgery: experience with 735 cases. Otol Neurotol. 2001; 22 223-230
8 Gjuric M. Enlarged middle fossa surgery: indications, advantages, and surgical technique. Mediterr J Otol. 2005; 1 128-135
9 House J W, Brackmann D E. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985; 93 146-147
10 Meyer T A, Canty P A, Wilkinson E P, Hansen M R, Rubinstein J T, Gantz B J. Small acoustic neuromas: surgical outcomes versus observation or radiation. Otol Neurotol. 2006; 27 380-392
11 Monsell E M, Balkany T A, Gates G A, Goldenberg R A, Meyerlesff W L, House J W. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg. 1995; 113 179-180
12 Friedman R A, Kesser B, Brackmann D E, Fisher L M, Slattery W H, Hitselberger W E. Long-term hearing preservation after middle fossa removal of vestibular schwannoma. Otolaryngol Head Neck Surg. 2003; 129 660-665
13 Arriaga M A, Chen D A. Facial function in hearing preservation acoustic neuroma surgery. Arch Otolaryngol Head Neck Surg. 2001; 127 543-546
14 Isaacson B, Telian S A, El-Kashlan H K. Facial nerve outcomes in middle cranial fossa vs translabyrinthine approaches. Otolaryngol Head Neck Surg. 2005; 133 906-910
15 Wiet R J, Mamikoglu B, Odom L, Hoistad D L. Long-term results of the first 500 cases of acoustic neuroma surgery. Otolaryngol Head Neck Surg. 2001; 124 645-651
16 Colletti V, Fiorino F. Is the middle fossa approach the treatment of choice for intracanalicular vestibular schwannoma?. Otolaryngol Head Neck Surg. 2005; 132 459-466
17 Wiegand D A, Ojemann R G, Fickel V. Surgical treatment of acoustic neuroma (vestibular schwannoma) in the United States: report from the Acoustic Neuroma Registry. Laryngoscope. 1996; 106(1 Pt 1) 58-66
18 Driscoll C L, Jackler R K, Pitts L H, Banthia V. Is the entire fundus of the internal auditory canal visible during the middle fossa approach for acoustic neuroma?. Am J Otol. 2000; 21 382-388
19 Kumon Y, Sasaki S, Kohno K et al.. Selection of surgical approaches for small acoustic neuromas. Surg Neurol. 2000; 53 52-60
20 Mangham Jr C A. Retrosigmoid versus middle fossa surgery for small vestibular schwannomas. Laryngoscope. 2004; 114 1455-1461
21 Arts H A, Telian S A, El-Kashlan H, Thompson B G. Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: results using the middle cranial fossa approach. Otol Neurotol. 2006; 27 234-241
22 Chee G H, Nedzelski J M, Rowed D. Acoustic neuroma surgery: the results of long-term hearing preservation. Otol Neurotol. 2003; 24 672-676
23 Brackmann D E, House J R, Hitselberger W E. Technical modifications to the middle fossa craniotomy approach in removal of acoustic neuromas. Am J Otol. 1994; 15 614-619
24 Gjuric M, Zizic Mitrecic M, Greess H, Berg M. Vestibular schwannoma volume as a predictor of hearing outcome after surgery. Otol Neurotol. 2007; 28 822-827
25 Thornton A R, Raffin M J. Speech discrimination scores modeled as a binomial variable. J Speech Hear Res. 1978; 21 507-518
26 Tucci D L, Telian S A, Kileny P R, Hoff J T, Kemink J L. Stability of hearing preservation following acoustic neuroma surgery. Am J Otol. 1994; 15 183-188
27 McKenna M J, Halpin C, Ojemann R G et al.. Long-term hearing results in patients after surgical removal of acoustic tumors with hearing preservation. Am J Otol. 1992; 13 134-136
28 Umezu H, Aiba T, Tsuchida S, Seki Y. Early and late postoperative hearing preservation in patients with acoustic neuromas. Neurosurgery. 1996; 39 267-271 discussion 271-272
29 Shelton C, Hitselberger W E, House W F, Brackmann D E. Hearing preservation after acoustic tumor removal: long-term results. Laryngoscope. 1990; 100(2 Pt 1) 115-119

Mislav GjuricM.D.

Kozarceva 18a

HR-10000 Zagreb, Croatia

Email: mislav.gjuric@zg.t-com.hr