Results in the Surgical Treatment of Giant Acoustic Neuromas

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

“…Total or NT resection was feasible in 46 of our 60 cases (76,7%), which is in line with other reports in the literature (16,19,20,46,52). In particular, T or NT resection was accomplished in 65,8% of cases with and 95,4% without tight adhesions of capsule to nervous structures (p<0,001).…”

“…A relatively large group of cystic tumors (14 out of 60 cases: 23,3%) was also observed among our Grade IV VS. According to several Authors (12,15,16,30) cystic VS did not show signs of greater adherence intraoperatively nor did they signi cantly affect the postoperative outcome. However, in the present series we observed in 12 out of 14 cystic cases (85,7%) tight adherences of capsule to nervous structures, in comparison to 56,5% (26 out of 46) of solid tumors (p<0,001).…”

“…However, the postoperative facial function preservation rate is quite different in the two studies, being 45% in Silva et al (50) and 75% in Samii et al (45). The preservation of FN functional state is of paramount importance in VS surgery and it is accomplished, as reported in the literature, in 32,9-83,3% of cases (16,19,26,45,62,65), with a metaanalysis demonstrating FN preservation in 60% of cases (52). The highest value of FN function preservation rate was reported by Zhang et al (18) in a cohort of patient who underwent subtotal resection instead of radical extirpation.…”

“…Similar rates are in line with the literature (19)(20)(21)26,45,47,57,58,61,62) and con rm that the retrosigmoid approach is safe and feasible to remove even giant lesions (20,26,45,47,50,57). The translabyrinthine approach has been traditionally advocated for this kind of tumors, with arguably good results in terms of extent of resection (rates of total resection being approximately 90%), postoperative facial outcome (HBI-III close to 75%) and perioperative complications (CSF leaks present in nearly 2% of cases) (5,10,16,27,47). On the other hand, perioperative complication rates as high as 14,3% have also been reported (16).…”

Evolution of Patients With Immediate Complete Facial Paralysis Secondary to Acoustic Neuroma Surgery

“…1,2 However, worse facial preservation rates between 52% and 78% have also been reported, especially in cases of large tumors. 3,4 The occurrence of an immediate total facial paralysis following AN surgery may reflect different physiopathological situations, including: total section of the nerve, partial section of the nerve, or anatomically preserved nerve with neurapraxia or axonotmesis. Each situation may lead to different outcomes.…”