Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T17:57:48.944Z Has data issue: false hasContentIssue false

Surgical management of vestibular schwannoma: attempted preservation of hearing and facial function

Published online by Cambridge University Press:  03 April 2013

T F Youssef
Affiliation:
Faculty of Medicine, Suez Canal University, Ismailia, Egypt
A Matter
Affiliation:
Faculty of Medicine, Suez Canal University, Ismailia, Egypt
M R Ahmed*
Affiliation:
Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*
Address for correspondence: Dr M R Ahmed, Lecturer in Otolaryngology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt Fax: +20 66 3415603 E-mail: [email protected]

Abstract

Background:

Vestibular schwannomas are benign tumours which usually originate from the vestibular portion of the VIIIth cranial nerve. Treatment options include observation with serial imaging, stereotactic radiation and microsurgical removal.

Aim:

The goal of surgery was complete eradication of tumour with preservation of hearing and facial nerve function.

Methods:

A retrospective review was undertaken of 24 cases of vestibular schwannoma jointly operated upon by a team of neurosurgeons and otologists at the Suez Canal University Hospital, with assessment of VIIth and VIIIth cranial nerve function, tumour size, and extent of growth. All surgery utilised a retromastoid, suboccipital approach.

Results:

Complete tumour removal was achieved in 19 patients. Anatomical preservation of the facial nerve was possible in 66.6 per cent of patients. Pre-operative, useful hearing was present in four patients, and preserved in 80 per cent. Cerebrospinal fluid leakage was diagnosed in two (8.3 per cent) patients, who responded to conservative therapy.

Conclusion:

The retromastoid, suboccipital surgical approach to the skull base can be safely and successfully achieved using a microsurgical technique, with minimal or no damage to neurovascular structures, even for large tumours.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Andersen, HT, Schrøder, SA, Bonding, P. Unilateral deafness after acoustic neuroma surgery: subjective hearing handicap and the effect of the bone-anchored hearing aid. Otol Neurotol 2006;27:809–14CrossRefGoogle ScholarPubMed
2Lin, D, Hegarty, JL, Fischbein, NJ, Jackler, RK. The prevalence of “incidental” acoustic neuroma. Arch Otolaryngol Head Neck Surg 2005;131:241–4CrossRefGoogle ScholarPubMed
3McLeod, B, Upfold, L, Taylor, A. Self reported hearing difficulties following excision of vestibular schwannoma. Int J Audiol 2008;47:420–30CrossRefGoogle ScholarPubMed
4Hansen, MR, Clark, JJ, Gantz, BJ, Goswami, PC. Effects of ErbB2 signaling on the response of vestibular schwannoma cells to gamma-irradiation. Laryngoscope 2008;118:1023–30CrossRefGoogle ScholarPubMed
5Chopra, R, Kondziolka, D, Niranjan, A, Lunsford, LD, Flickinger, JC. Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 2007;68:845–51CrossRefGoogle Scholar
6Koerbel, A, Gharabaghi, A, Safavi-Abbasi, Tatagiba, M, Samii, M. Evolution of vestibular schwannoma surgery: the long journey to current success. Neurosurg Focus 2005;18:e10CrossRefGoogle Scholar
7Nayak, PK, Kumar, R. Retromastoid-sub occipital: a novel approach to cerebello pontine angle in acoustic neuroma surgery – our experience in 21 cases. J Neurosci Rural Pract 2011;2:23–6Google ScholarPubMed
8Yang, SM, Yu, LM, Han, DY. Technique of hearing preservation during acoustic neuroma surgery [in Chinese]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008;43:564–9Google ScholarPubMed
9Misra, BK, Purandare, HR, Ved, RS, Bagdia, AA, Mare, PB. Current treatment strategy in the management of vestibular schwannoma. Neurol India 2009;57:257–63CrossRefGoogle ScholarPubMed
10Timmer, FC, Graamans, K. A large vestibular schwannoma that did not grow for 18 years. B-ENT 2011;7:305–7Google ScholarPubMed
11House, JW, Brackmann, DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146–7CrossRefGoogle ScholarPubMed
12Gardner, G, Robertson, JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1988;97:5566CrossRefGoogle ScholarPubMed
13Kim, E, Nam, SI. Staging in vestibular schwannoma surgery: a modified technique. J Korean Neurosurg Soc 2008;43:5760CrossRefGoogle ScholarPubMed
14Yamakami, I, Uchino, Y, Kobayashi, E, Yamaura, A, Oka, N. Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neurol Neurosurg Psychiatry 2004;75:453–8CrossRefGoogle ScholarPubMed
15Cohen, NL. Acoustic neuroma surgery with emphasis on preservation of hearing. Laryngoscope 1979;89:886–96CrossRefGoogle ScholarPubMed
16Glasscock, ME, Hays, JW, Minor, LB, Haynes, DS, Carrasco, VN. Preservation of hearing in surgery for acoustic neuromas. J Neurosurg 1993;78:864–70CrossRefGoogle Scholar
17Mazzoni, A, Calabrese, V, Danesi, G, De Nigris, M. The suboccipital approach in functional surgery of acoustic neuroma [in Italian]. Acta Otorhinolaryngol Ital 1993;13:311Google ScholarPubMed
18Sampath, P, Rini, D, Long, DM. Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases. J Neurosurg 2000;92:70–8CrossRefGoogle ScholarPubMed
19Bentivoglio, P, Cheesman, AD, Symon, L. Surgical treatment of acoustic neuromas during the last five years: part II – results for facial and cochlear nerve function. Surg Neurol 1988;29:205–9CrossRefGoogle ScholarPubMed
20Kondziolka, D, Lunsford, LD, Flickinger, JC. Comparison of management options for patients with acoustic neuromas. Neurosurg Focus 2003;14:e1CrossRefGoogle ScholarPubMed
21Torrens, M, Maw, R, Coakham, H, Butler, S, Morgan, H. Facial and acoustic nerve preservation during excision of extracanalicular acoustic neuromas using the suboccipital approach. Br J Neurosurg 1994;8:655–65CrossRefGoogle ScholarPubMed
22Kurokawa, Y, Uede, T, Ohtaki, M, Tanabe, S, Hashi, K. Hearing preservation and tinnitus following removal of acoustic neurinomas [in Japanese]. No Shinkei Geka 1996;24:329–34Google ScholarPubMed
23Anderson, DE, Leonetti, J, Wind, JJ, Cribari, D, Fahey, K. Resection of large vestibular schwannoma: facial nerve preservation in the context of surgical approach and patient-assessed outcome. J Neurosurg 2005;102:643–9CrossRefGoogle ScholarPubMed
24Betchen, SA, Walsh, J, Post, KD. Long-term hearing preservation after surgery of vestibular schwannoma. J Neurosurg 2005;102:69CrossRefGoogle ScholarPubMed