527 Fully Endoscopic Resections of Vestibular Schwannomas

Abstract

Background: We report a series of 527 patients with unilateral vestibular schwannomas (VS) who underwent fully endoscopic resection of their tumors during the period of October, 2001 to July, 2010. Patients’ outcomes were evaluated, with specific regard to hearing preservation, facial nerve function, postoperative complications and completeness of the resection.

Methods: The patient population consisted of 527 cases with unilateral VS(s); patients with neurofibromatosis type 2 (NFT2) were excluded from this study. Tumors ranged in size from 0.3–5.8 cm, most tumors were less than 4 cm in diameter (mean: 2.8 cm). Tumors were removed via 2.0 cm “keyhole” retrosigmoid craniotomies.

Results: Utilizing the fully endoscopic technique, 94% of tumors were completely removed; subtotal removal was performed in 6% of patients in an attempt to preserve their hearing. Anatomic preservation of the facial nerve was achieved in all of the patients. Functionally, measurable hearing (serviceable/some) was preserved in 57% of cases that had either “serviceable” or “some” hearing pre-operatively. There were no major neurological complications such as quadriparesis, hemiparesis, bacterial or aseptic meningitis, permanent lower cranial nerve deficits, or deaths.

Conclusion: From our experience, we conclude that the endoscope is ideally suited for a minimally invasive approach for resection of vestibular schwannomas.

Key words

endoscopy - vestibular schwanoma - minimally invasive neurosurgery - key-hole approach

References

• 1 Shiffman F, Dancer J, Rothballer AB. et al . The diagnosis and evaluation of acoustic neuromas.  Otolaryngol Clin North Am. 1973;  6 189-228
• 2 Rosenberg SI. Natural history of acoustic neuromas.  Laryngoscope. 2000;  110 497-508
• 3 Lanser MJ, Sussman SA, Frazer K. Epidemiology, pathogenesis, and genetics of acoustic tumors.  Otolaryngol Clin North Am. 1992;  25 499-520
• 4 Nager GT. Acoustic neurinomas.  Acta Otolaryngol (Stockh). 1985;  99 245-261
• 5 Tos M, Charabi S, Thomsen J. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results.  Eur Arch Otorhinolaryngol. 1998;  255 1-6
• 6 Selesnick SH, Jackler RK. Clinical manifestations and audiologic diagnosis of acoustic neuromas.  Otolaryngol Clin North Am. 1992;  25 521-551
• 7 Cushing H. Tumors of the nervus acusticus and the syndrome of the cerebellopontine angle.. W.B. Saunders, Philadelphia/London; 1917
• 8 Low WK. Enhancing hearing preservation in endoscopic-assisted excision of acoustic neuroma via the retrosigmoid approach.  J Laryngol Otol. 1999;  113 973-977
• 9 Magnan J, Barbieri M, Mora R. et al . Retrosigmoid approach for small and medium-sized acoustic neuromas.  Otol Neurotol. 2002;  23 141-145
• 10 Eby JBC, Shahinian HK. Fully endoscopic vascular decompression of the facial nerve for hemifacial spasm.  Skull Base: An Interdisciplinary Approach. 2001;  11 189-196
• 11 Jarrahy R, Berci G, Shahinian HK. Endoscope-assisted microvascular decompression of the trigeminal nerve.  Otolaryngol Head Neck Surg. 2000;  123 218-223
• 12 Jarrahy R, Cha ST, Berci G. et al . Fully endoscopic vascular decompression of the glossopharyngeal nerve.  J Craniofacial Surg. 2002;  13 90-95
• 13 Jarrahy R, Eby JB, Cha ST. et al . Fully endoscopic vascular decompression of the trigeminal nerve.  Minim Invas Neurosurg. 2002;  45 32-35
• 14 Shahinian HK, Eby JB, Ocon M. Fully endoscopic excision of vestibular schwannomas.  Minim Invas Neurosurg. 2004;  47 329-332
• 15 Kabil MS, Shahinian HK. A series of 112 fully endoscopic resections of vestibular schwannomas.  Minim Invas Neurosurg. 2006;  49 362-368
• 16 House J, Brachman DE. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
• 17 Robinette MS, Bauch CD, Olsen WO. et al . Auditory brainstem response and magnetic resonance imaging for acoustic neuromas.  Arch Otolaryngol Head Neck Surg. 2000;  126 963-966
• 18 Ramsay HA, Luxford WM. Treatment of acoustic tumours in elderly patients: Is surgery warranted?.  J Laryngol Otol. 1993;  107 295-297
• 19 House WF, Monograph I. Transtemporal bone microsurgical removal of acoustic neurinomas.  Arch Otolaryngol. 1964;  80 597-756
• 20 Drake CG. Total removal of large acoustic neuromas.  J Neurosurg. 1967;  26 554-561
• 21 Rand R, Kurze T. Preservation of vestibular, cochlear and facial nerves during microsurgical removal of acoustic tumors: Report of two cases.  J Neurosurg. 1968;  28 158-161
• 22 Cohen NL. Retrosigmoid approach for acoustic tumor removal.  Otolaryngol Clin North Am. 1992;  25 295-310
• 23 Hardy DG, MacFarlane R, Baguley D. et al . Surgery for acoustic neuroma. An analysis of 100 translabyrinthine operations.  J Neurosurg. 1989;  71 799-804
• 24 Axon PR, Ramsden RT. Facial nerve injury caused by vestibular schwannoma compression: severity and adaptation to maintain normal clinical facial function.  Am J Otol. 1999;  20 763-769
• 25 Post KD, Eisenberg M, Catalano P. Hearing preservation in vestibular schwannoma surgery: what factors influence the outcome?.  J Neurosurg. 1995;  83 191-196
• 26 Samii M, Matthies C. Management of 1 000 vestibular schwannomas: surgical management and results.  Neurosurgery. 1997;  40 11-23
• 27 Tos M, Thomsen J, Harmsen A. Is preservation of hearing acoustic neuroma worthwhile?.  Acta Otolaryngol (Stockh). 1988;  452 57-68
• 28 Horrax G, Poppen JL. The end results of complete versus intracapsular removal of acoustic tumors.  Ann Surg. 1949;  130 567-575
• 29 Wiet RJ, Teixido M, Liang JG. Complications in acoustic neuroma surgery.  Otolaryngol Clin North Am. 1992;  125 389-412
• 30 Selesnick SH, Deora M, Drotman MB. et al . Incidental discovery of acoustic neuromas.  Otolaryngol Head Neck Surg. 1999;  120 815-818

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