Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Harati, Ali; Scheufler, Kai-Michael; Schultheiß, R.; Tonkal, Albaraa; Harati, Kamran; Oni, Paul; Deitmer, Thomas

doi:10.4103/sni.sni_129_16

Cited by 27 publications

(13 citation statements)

References 55 publications

(100 reference statements)

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“…However, even with meticulous surgical techniques, neurological complications often occur after surgical treatment for schwannomas. For vestibular schwannomas, microscopic procedures were reported to be useful for reducing neural injury [6]. However, to the best of our knowledge, no study has investigated the utility of the microsurgical technique using a microscope or loupe magnification in the treatment of schwannomas located in the extremities.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for complications after surgical treatment for schwannomas of the extremities

Kobayashi

Akiyama

Okuma

et al. 2019

BMC Musculoskelet Disord

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Background Schwannomas are well-encapsulated, benign neoplasms, and enucleation is a standard operation procedure. The incidence of neurological complications after surgical treatment for schwannomas of the extremities varies, and there is no consensus concerning predictive factors for complications. The aim of this study was to elucidate predictive factors for complications after surgical treatment of schwannomas that develop in the major nerves of the extremities. Methods A total of 139 patients with 141 schwannomas arising in major nerves were retrospectively analyzed. Data regarding preoperative clinical features, the postoperative neurological complications, and clinical course of complications, with a median follow-up period of 2 months (range, 0.5–96), were obtained. Predictive factors for complications were statistically analyzed. Results Postoperative complications occurred in 49 lesions (34.8%), including 42 with sensory disturbance and 8 with motor weakness. In univariate analysis, older age, tumors originating from the upper extremity, and major motor nerve involvement were associated with a higher complication rate ( p = 0.03, p = 0.003, and p = 0.001, respectively). In multivariate analysis, major motor nerve involvement was an independent predictive factor for postoperative complications ( p = 0.03). Almost all complications gradually improved, but 6 out of 8 patients with motor weakness did not show full recovery at the final follow-up. Conclusions Schwannomas originating from major motor nerves can lead to a higher risk for postoperative complications.

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Section: Introductionmentioning

confidence: 99%

Predictive factors for complications after surgical treatment for schwannomas of the extremities

Kobayashi

Akiyama

Okuma

et al. 2019

BMC Musculoskelet Disord

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“…In our institution, we follow the principle of attempting total resection under the constant surveillance of neurophysiological monitoring which means halting resection when alterations in facial nerve responses suggest potential severe damage. Looking at current experience and comparing to updated literature review, there seems to be a good agreement of results with modern large series [25][26][27][28][29][30][31][32][33] for both functional outcomes and resection strategies (►Table 8). These data are more relevant if one considers the fact that most of our patients were operated on by skull-base surgeons who were at the beginning of their careers.…”

Section: Discussionmentioning

confidence: 70%

Early-Career Surgical Practice for Cerebellopontine Angle Tumors in the Era of Radiosurgery

et al. 2017

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We analyzed the outcomes of patients with large cerebellopontine angle (CPA) tumors treated by a skull-base team in which two surgeons (one neurosurgeon and one otological surgeon) were in the beginning of their careers (<40 years old). Data of patients operated on between April 2012 and March 2016 were reviewed. All factors related to surgical training were considered. Thirty-one patients had vestibular schwannomas, while 26 had meningiomas. Mean tumor diameter was 30.6 mm (range, 23-49 mm) for schwannomas and 35 mm (range, 22-51 mm) for meningiomas. Satisfactory postoperative facial nerve function (House-Brackmann's grade I or II) was achieved in 20 (64.5%) schwannoma patients and 21 (80.7%) meningioma patients. Gross total and near-total resections (residual tumor < 5 mm) were achieved in 21 (67.7%) and 9 (29%) schwannoma patients, respectively. Gross total resection (Simpson's grade II) was achieved in 18 (69.2%) meningioma patients. In both groups, the retrosigmoid approach was the most common approach. Regarding surgical training of the two younger surgeons, during the residency period, they attended high-volume centers for CPA tumors. Application of microsurgical techniques was systematically applied from the beginning of their personal series in every intracranial pathology case. During the first 2 years of the series, they were supervised by more experienced surgeons and followed a stepwise sharing of increasingly difficult surgical phases; by comparing results of this period with the last 2 years of the series, where they acquired a complete autonomy, no relevant difference was detected. Our results suggest that young surgeons may achieve good results even at the beginning of their careers, if specific conditions related to training and mentorship are met.

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“…Eighty-three studies report on VS surgery, where GTR was not achieved or an intentional less-than-total resection was accepted in some patients within the reported cohorts. Thirty out of these studies (Sugita and Kobayashi, 1982 ; Bentivoglio et al, 1988 ; Ebersold et al, 1992 ; Samii et al, 1992 , 2006 , 2010 ; Cerullo et al, 1993 ; Comey et al, 1995 ; Post et al, 1995 ; Colletti et al, 1997 ; Jung et al, 2000 ; Watanabe et al, 2003 ; Yamakami et al, 2004 ; Zhang et al, 2005 ; Sinha and Sharma, 2008 ; Misra et al, 2009 ; Gerganov et al, 2010 ; Zhao et al, 2010 ; Arlt et al, 2011 ; Haque et al, 2011 ; Nayak and Kumar, 2011 ; Pan et al, 2012 ; Iwai et al, 2015 ; Jeltema et al, 2015 ; Turel et al, 2015 ; Harati et al, 2017 ; Huang et al, 2017a , b ; Zumofen et al, 2018 ; Taha et al, 2020 ) exclusively using the RSM approach report <100% GTR rates in n = 4,131 individuals. About 48.4% of the individuals suffered from post-operative FN impairment, of which 23.4% had moderate and 12.7% severe FN palsy.…”

Section: Systematic Review Of the Literaturementioning

confidence: 99%

Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery–A Systematic Review and Future Perspectives

Hostettler

Jayashankar

Bikis

et al. 2021

Front. Bioeng. Biotechnol.

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Background and purpose: Tumorous lesions developing in the cerebellopontine angle (CPA) get into close contact with the 1st (cisternal) and 2nd (meatal) intra-arachnoidal portion of the facial nerve (FN). When surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery. This article aims to provide a systematic overview for translational research by establishing the current evidence on available clinical studies and experimental models reporting on intracranial FN injury.Methods: A systematic literature search of several databases (PubMed, EMBASE, Medline) was performed prior to July 2020. Suitable articles were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Included clinical studies were reviewed and categorized according to the pathology and surgical resection strategy, and experimental studies according to the animal. For anatomical study purposes, perfusion-fixed adult New Zealand white rabbits were used for radiological high-resolution imaging and anatomical dissection of the CPA and periotic skull base.Results: One hundred forty four out of 166 included publications were clinical studies reporting on FN outcomes after CPA-tumor surgery in 19,136 patients. During CPA-tumor surgery, the specific vulnerability of the intracranial FN to stretching and compression more likely leads to neurapraxia or axonotmesis than neurotmesis. Severe FN palsy was reported in 7 to 15 % after vestibular schwannoma surgery, and 6% following the resection of CPA-meningioma. Twenty-two papers reported on experimental studies, out of which only 6 specifically used intracranial FN injury in a rodent (n = 4) or non-rodent model (n = 2). Rats and rabbits offer a feasible model for manipulation of the FN in the CPA, the latter was further confirmed in our study covering the radiological and anatomical analysis of perfusion fixed periotic bones.Conclusion: The particular anatomical and physiological features of the intracranial FN warrant a distinguishment of experimental models for intracranial FN injuries. New Zealand White rabbits might be a very cost-effective and valuable option to test new experimental approaches for intracranial FN regeneration. Flexible and bioactive biomaterials, commonly used in skull base surgery, endowed with trophic and topographical functions, should address the specific needs of intracranial FN injuries.

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Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Cited by 27 publications

References 55 publications

Predictive factors for complications after surgical treatment for schwannomas of the extremities

Predictive factors for complications after surgical treatment for schwannomas of the extremities

Early-Career Surgical Practice for Cerebellopontine Angle Tumors in the Era of Radiosurgery

Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery–A Systematic Review and Future Perspectives

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