Image-guided drainage of cystic vestibular schwannomata

Barrett, Chris; Prasad, K. S. Manjunath; Hill, John J.; Johnson, I.; Heaton, Judith M.; Crossman, John; Mendelow, A. D.

doi:10.1007/s00701-009-0493-0

Cited by 5 publications

(1 citation statement)

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“…[ 36 ] Recently, image-guided insertion of a valveless cystoperitoneal shunt as a palliative procedure in elderly patients who are at high risk for traditional surgical approaches has been described. [ 37 ] Though cystic VS have low proliferative index, residual cystic VS show rapid re-growth and require re-operation as compared to residual solid VS that have slow growth potential. [ 28 ] Recurrent cystic VS are even more surgically challenging, as they are associated with small chance of complete tumor removal and facial nerve preservation.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcome in cystic vestibular schwannomas

et al. 2016

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Background:Cystic vestibular schwannomas (VS) form a rare subgroup that differs from the solid variant clinically, radiologically, and histopathologically. These tumors also vary in their surgical outcome and carry a different risk of post-operative complications. We analyzed our series of 64 patients with cystic VS and discuss the technical difficulties related to total excision of these tumors and focus on complication avoidance.Materials and Methods:A retrospective review of cystic VS surgically managed over a span of 11 years. The case records were evaluated to record the clinical symptoms and signs, imaging findings, surgical procedure, complications, and follow-up data. Post-operative facial nerve palsy was analyzed with respect to tumor size and tumor type.Results:Progressive hearing impairment was the most common initial symptom (76.6%). Atypical initial symptoms were present in 15 patients (23.4%). Preoperatively, 78% patients had good facial nerve function (HB grade 1, 2) and 22% had intermediate (HB grade 3, 4) to poor (HB grade 5 and 6) function. Mean tumor size was 4.1 cm. Complete tumor removal was achieved in 53 patients (83%). The facial nerve was anatomically intact but thinned out after tumor excision in 38 patients (59.4%). Ninety percent patients had either intermediate or poor facial nerve function at follow-up. Poor facial nerve outcome was associated with giant tumors and peripherally located, thin-walled cystic tumors.Conclusion:Resection of cystic VS is complicated by peritumoral adhesions of the capsule to the nerve. Extensive manipulation of the nerve in order to dissect the tumor–nerve barrier results in worse facial nerve outcome. The outcome is worse in peripherally located, thin-walled cystic VS as compared to centrally located, thick-walled cystic tumors. Subtotal excision may be justified, especially in tumors with dense adhesion of the cyst wall to the facial nerve in order to preserve nerve integrity.

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Section: Discussionmentioning

confidence: 99%