An Algorithm for the Management of Acoustic Neuromas regarding Age, Hearing, Tumor Size, and Symptoms

Silverstein, Herbert; Rosenberg, Seth I.; Flanzer, John M.; Wanamaker, Hayes H.; Seidman, Michael D.

doi:10.1177/019459989310800101

Cited by 54 publications

(37 citation statements)

References 22 publications

(3 reference statements)

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“…1-14, 16-22,24-30,33-37,39,40-43,45-60 Certainly, it has been demonstrated in several studies, including our own, that tumor size is a primary determinant in our endeavors to preserve hearing. 1,[15][16][17]19,42,47,53,59 Review of the present series adds another data set to support the finding that the smaller the tumor, the more likely that hearing will be preserved after surgical resection. Other variables have been considered in an attempt to formulate a set of conditions that is most likely to result in postoperative hearing preservation.…”

Section: Hearing Preservationsupporting

confidence: 61%

Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas

Koos

Day²,

Matula³

et al. 1998

Journal of Neurosurgery

294

157

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Hearing preservation postsurgery by tumor type was as follows: 1A, 92%; 1B, 88%; 1C, 100%; 2A, 83%; 2B, 92%; and 3, 57%. Combined, this represents a hearing preservation rate of 87% after surgical treatment of Grade II acoustic neurinomas. Full nerve function was maintained in 88% of patients with anatomically preserved facial nerves in both Grade I and II tumors. The remaining 12% of patients retained partial function of the facial nerve. Two patients in the series lost anatomical integrity of the nerve due to surgery.

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Section: Hearing Preservationsupporting

confidence: 61%

Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas

Koos

Day²,

Matula³

et al. 1998

Journal of Neurosurgery

294

157

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“…It has been postulated that surgical debulking devascularizes tumors, thereby reducing regrowth potential (6,14). However, recent data suggest that postsurgical tumors display growth patterns as variable as primary tumors with regrowth rates as high as 60% (12,15). This is confirmed by our study, which found only 11% (4 of 36) of subtotal excisions from primary surgery initially followed on a postoperative watch-andrescan strategy subsequently required revision surgery, whereas 6 of 11 subtotal excisions after first-revision surgery needed further treatment.…”

Section: Discussionmentioning

confidence: 99%

Revision Surgery for Residual or Recurrent Vestibular Schwannoma

Freeman¹,

Ramsden²,

Saeed³

et al. 2007

Otology &Amp; Neurotology

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Most residual tumors after primary surgery are successfully managed with watch and rescan. Tumor fragment size is the greatest determinant of revision treatment. After revision surgery, tumor regrowth is much less predictable. Revision surgery is usually considerably more difficult than primary surgery, with a higher complication rate, particularly with regard to the facial nerve. Changing the approach for revision surgery may confer an advantage to facial nerve function.

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“…Many physicians choose the conservative approach if patients have small tumors, 18 minimal or no symptoms, poor overall health status, or if they are elderly, 24,33,87 but this approach may still result in hearing loss over time. 35,41,65,70,91 Radiosurgery is often chosen for patients with tumors smaller than 2.5 cm or for the elderly.…”

mentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

249

216

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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An Algorithm for the Management of Acoustic Neuromas regarding Age, Hearing, Tumor Size, and Symptoms

Cited by 54 publications

References 22 publications

Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas

Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas

Revision Surgery for Residual or Recurrent Vestibular Schwannoma

Surgery for vestibular schwannomas: a systematic review of complications by approach

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