Treatment of Large and Giant Residual and Recurrent Vestibular Schwannomas

Ricardo Ramina; Maurício Coelho Neto; Kelly Cristina Bordignon; Tobias Mattei; Rogério Clemente; Paulo Henrique Pires Aguiar

doi:10.1055/s-2006-953510

Skull Base 2007; 17(2): 109-117
DOI: 10.1055/s-2006-953510

ORIGINAL ARTICLE

Treatment of Large and Giant Residual and Recurrent Vestibular Schwannomas

Ricardo Ramina¹ , Maurício Coelho Neto¹ , Kelly Cristina Bordignon¹ , Tobias Mattei² , Rogério Clemente¹ , Paulo Henrique Pires Aguiar²

¹Neurosurgical Department, Neurological Institute of Curitiba, Curitiba, Brazil
²Neurosurgical Department, University of São Paulo, São Paulo, Brazil

Abstract

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

Full Text

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Ricardo RaminaM.D.

R. Gonçalves Dias 713

80240-340 Curitiba, Brazil

Email: ramina@bsi.com.br