The issue of recurrence of vestibular schwannomas is poorly studied by the surgical literature and is probably underestimated. Our own long-term retrospective analysis after translabyrinthine approach has indicated a 9.2% recurrence rate. This long-term event is mainly due to regrowth of microfragments that have been left in the operative field along the course of the facial nerve or at the surface of the pons. Management of recurrence depends on the tumor size and patient's condition. Our current policy is to propose a Gamma Knife radiosurgical treatment in eligible cases. Prospective long-term follow-up studies using serial MR imaging after radical removal should bring reliable data about the incidence of vestibular schwannoma recurrence.
Two cases of spontaneous fluid fistula through the umbilicus connected with the drainage from a ventriculoperitoneal shunt are described. In neither case was it necessary to remove the shunt.
Current microsurgical treatment of vestibular schwannomas usually brings satisfactory results for the patients. However, transient or permanent complications may occur, especially when treating large tumors. Precise information about these potential complications has to be given to the patient at the time of the surgical decision. Based on their personal experience of large operated vestibular schwannomas and analyzing a review of the international literature, the authors detail these complications and the way to prevent and manage them. The problems that are linked to the variety of surgical approaches are also commented. The most frequent complication is cerebrospinal fluid leak that requires medical management and in less than one third of cases, surgical exploration. Vascular problems including ischemia or hemorrhage inside the posterior fossa represent the main source of permanent morbidity. Lower cranial nerve deficits are unusual but may expose to early and delayed aspiration pneumonias. The authors conclude that careful selection of cases, meticulous operative management and intensive postoperative care are essential steps to prevent and to treat these complications.
Early treatment of intracanalicular vestibular schwannomas (IVSs) may be advisable because their spontaneous course will show hearing loss in most cases. Advanced microsurgical techniques and continuous intraoperative monitoring of cranial nerves may allow hearing preservation (HP) without facial nerve damage. However, there are still controversies about the definition of HP and the best surgical approach that should be used. In this study, we reviewed the main data from the recent literature on IVS surgery and compared hearing, facial function and complication rates after the retrosigmoid and middle fossa approaches, respectively. The results showed that the average HP rate is approximately 45% after IVS surgery whatever the surgical route. HP varied widely depending on the audiometric criteria that were used for definition of serviceable hearing. There was a trend to show that middle fossa approach offered a better quality of postoperative hearing (not statistically significant), whereas the retrosigmoid approach offered a better facial nerve preservation and fewer complications (not statistically significant). We believe that the timing of treatment in the course of the disease and selection between radiosurgical versus microsurgical procedure are key issues in the management of IVS. Once open surgery has been decided, selection of the approach mainly depends on individual anatomical considerations and experience of the surgeon.
The neurological manifestations of eight patients with osseous fibrous dysplasia of skull were retrospectively studied. In this series, the frontal bone was involved in 75% of the patients, the sphenoid or temporal bones in 37.5%, and the parietal in 25%. It was observed that cranial deformities occurred in all but one case, headache was present in 87.5% of the patients, visual disturbances in 50%, proptosis in 25%, and auditive symptoms in 12.5%. Six out of the eight patients were operated on: three of the four who presented progressive visual loss had postoperative improvement. In their follow up, none presented, until now, evidence of recurrence or worsening of symptoms, confirming the benign nature of fibrous dysplasia.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations鈥揷itations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright 漏 2024 scite LLC. All rights reserved.
Made with 馃挋 for researchers
Part of the Research Solutions Family.