Long-Term Hearing Preservation Outcomes for Small Vestibular Schwannomas: Retrosigmoid Removal Versus Observation

Zhu, Weidong; Chen, Hongsai; Jia, Hong-Ti; Chai, Yimin; Yang, Jie; Wang, Zhaoyan; Wu, Hao

doi:10.1097/mao.0000000000001684

Cited by 31 publications

(25 citation statements)

References 29 publications

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“…While some studies reported data limited exclusively to tumors completely confined to the IAC without cisternal involvement, others presented data on ''small'' tumors defined as purely intracanalicular or with \15-mm CPA extension. 26,27 In a retrospective study of 94 patients who underwent retrosigmoid resection, HP was 50% for intracanalicular tumors and 29% for tumors with extrameatal extension. 28 Staecker et al compared hearing outcomes between patients who underwent middle cranial fossa and retrosigmoid approaches and reported a HP rate of 47% for intracanalicular tumors, whereas no hearing was preserved for larger tumors with an average size of 1.3 cm.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Radiographic Predictors of Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannomas

Ren

Tawfik

Mastrodimos

et al. 2020

Otolaryngol.--head neck surg.

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Objective To identify preoperative radiographic predictors of hearing preservation (HP) after retrosigmoid resection of vestibular schwannomas (VSs). Study Design Retrospective case series with chart review. Setting Tertiary skull base referral center. Methods Adult patients with VSs <3 cm and word recognition scores (WRSs) ≥50% who underwent retrosigmoid resection and attempted HP between February 2008 and December 2018 were identified. Pure tone average (PTA), WRS, and magnetic resonance imaging radiographic data, including tumor diameter and dimensional extension relative to the internal auditory canal (IAC), were examined. Results A total of 151 patients were included. The average tumor size was 13.8 mm (range, 3-28). Hearing was preserved in 41.7% (n = 63). HP rates were higher for intracanalicular tumors than tumors with cerebellopontine angle (CPA) components (57.6% vs 29.4%, P = .03). On multivariate analysis, maximal tumor diameter (odds ratio [OR], 0.892; P < .001) and preoperative PTA (OR, 0.974; P = .026) predicted HP, while mediolateral tumor diameter predicted postoperative PTA (OR, 1.21; P = .005) and WRS (OR, –1.89; P < .001). For tumors extending into the CPA, younger age (OR, 0.913; P = .012), better preoperative PTA (OR, 0.935; P = .049), smaller posterior tumor extension (OR, 0.862; P = .001), and smaller caudal extension relative to the IAC (OR, 0.844; P = .001) all predicted HP. Conclusion Rates of HP are highest in patients with small intracanalicular VSs and good preoperative hearing. For tumors extending into the CPA, greater posterior and caudal tumor extension relative to the IAC may portend worse hearing outcomes.

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Section: Discussionmentioning

confidence: 99%

Preoperative Radiographic Predictors of Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannomas

Ren

Tawfik

Mastrodimos

et al. 2020

Otolaryngol.--head neck surg.

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“…The suboccipital retrosigmoid approach commonly used in the management of lesions of the cerebellopontine angle including vestibular schwannoma, choleostoma, trigeminal neuralgia, and facial spasm (1)(2)(3)(4)(5)(6)(7). It is characterized by a minimal incisions and bone flaps measuring 4 cm and 20 × 25 cm, respectively.…”

Section: Introductionmentioning

confidence: 99%

Developing a Method to Precisely Locate the Keypoint During Craniotomy Using the Retrosigmoid Keyhole Approach: Surgical Anatomy and Technical Nuances

Jian

Sheng

et al. 2021

Front. Surg.

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Objective: To explore the precise location of the keypoint during craniotomy using the retrosigmoid keyhole approach.Methods: This study included 20 dry skulls and 10 wet cadaveric specimens. On the inner surface of dry skulls, the junction between the inferior margin of the transverse sinus (ITS) and the posterior margin of the sigmoid sinus (TSJ) was marked. The keypoint (D) was identified as the TSJ's corresponding point on the external surface of the temporal mastoid process (MP). The distance from the keypoint to the top point of the digastric groove, mastoidale, and asterion were noted (AD, BD, CD, respectively). A method to accurately locate the keypoint was developed based on these relationships. The developed method was used on the wet cadaveric specimens to evaluate its accuracy, safety, rapidity, and minimal invasion.Results: No significant difference was found between the AD, BD, and CD of the left and right sides. The drilling point was oriented on a straight line 12 mm above the top point of digastric groove, perpendicular to the Frankfort horizontal plane (FHP). In the cadaveric specimens, the operative area was clearly exposed. No venous sinus rupture occurred. The average craniotomy time was 28.74 ± 3.89 min.Conclusions: A potentially safe, accurate, and rapid craniotomy procedure was developed with the added advantage of preserving the visibility of the operating field and preventing venous sinus injury.

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“…Several guidelines and systematic reviews have been published, even recently, which concerned alternative management procedures including wait‐and‐scan (WaS), MSR, or SRS without a high level of evidence owing to the lack of prospective studies and the numerous elements involved in the decision making process, such as the tumor features, presenting symptoms, technique development, and patient willingness 9,10 . To date, the great majority of studies published about long‐term outcomes under different management procedures were less than 10 years 11–13 …”

Section: Introductionmentioning

confidence: 99%

Management and Outcomes of Sporadic Vestibular Schwannoma: A Longitudinal Study Over 12 Years

et al. 2020

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Objectives To evaluate the management of sporadic vestibular schwannomas (VS) with a 12‐year follow‐up. Study Design Retrospective study of all VS patients initially treated in 2005 in a tertiary referent center. Methods Initial decision making for microsurgical resection (MSR) or wait‐and‐scan (WaS) was according to VS size and hearing; subsequently, MSR or stereotactic radiosurgery (SRS) was proposed dependent on VS growth and size, hearing, and patient's age or willingness. Results Two hundred and one sporadic VS were included. The first management apportionment was 120 WaS (61.5%), 72 MSR (37%), three SRS (1.5%), and six others refused MSR and were lost to follow‐up (LFU). Within 1 year, 95 (47%) VS were surgically removed; 17 (8.5%) were treated by SRS; and 35 (17.5%) were LFU. The proportions for SRS and LFU were virtually unchanged for the following years, and the proportion under MSR increased slightly within 3 years and then remained stable. Finally, at 12 years, 104 (51.5%) cases had been operated on, 21 (10.5%) treated by SRS, 23 (11.5%) still under WaS, and 53 (26.5%) LFU, which were mainly intracanalicular. The initially and subsequently operated cases presented similar hearing preservation rates and good facial nerve function outcomes. Conclusion This longitudinal study of a large number of VS, which were diagnosed over a short period of time and followed for 12 years, provides new information on both the natural history of these benign tumors and individual patient concerns. This study recommends use of the WaS policy for small and mid‐sized VS before active therapeutic decision making. Level of Evidence 3 Laryngoscope, 131:E970–E976, 2021

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Long-Term Hearing Preservation Outcomes for Small Vestibular Schwannomas: Retrosigmoid Removal Versus Observation

Cited by 31 publications

References 29 publications

Preoperative Radiographic Predictors of Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannomas

Preoperative Radiographic Predictors of Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannomas

Developing a Method to Precisely Locate the Keypoint During Craniotomy Using the Retrosigmoid Keyhole Approach: Surgical Anatomy and Technical Nuances

Management and Outcomes of Sporadic Vestibular Schwannoma: A Longitudinal Study Over 12 Years

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