Staging in giant vestibular schwannoma surgery: A two consecutive day technique for complete resection in basic neurosurgical setups

Abstract

Introduction: Vestibular schwannomas constitute 8% of all intracranial tumors. A majority of vestibular schwannomas are sporadic and unilateral. Giant vestibular schwannomas are seen in our country due to the late diagnosis and long duration of symptoms before diagnosis. These giant schwannomas are challenging to manage as most of the patients are having brainstem compression. Materials and Methods: Twelve cases of a giant vestibular schwannoma were operated in our department between May 2011 and December 2012. Vestibular schwannomas with a maximal diameter of more than 4 cm were defined as a giant vestibular schwannoma. All the patients had a unilateral vestibular schwannoma. Performance status of all the patients were graded as per the Karnofsky performance score. Pre-operative assessment of 5 th , 7 th , 8 th and lower cranial nerve status was done in all cases. Ventriculoperitoneal shunting was done pre-operatively in all cases. All patients were operated through retromastoid suboccipital craniectomy and retrosigmoid approach. These patients were operated in two stages in two consecutive days with overnight elective ventilation in ICU. Ultrasonic aspirator and nerve monitoring techniques were not used. Results: Giant acoustic schwannomas can be safely resected completely by a staged resection on two consecutive days without any increased morbidity or mortality. This technique may be employed to achieve complete resection of such lesions without deterioration of facial nerve function in institutions which do not have advanced facilities like nerve monitoring or ultrasonic aspirator.

A Systematic Analysis of the Reliability of Diffusion Tensor Imaging Tractography for Facial Nerve Imaging in Patients with Vestibular Schwannoma

“…The method of treatment with the best postoperative results 1 for patients with vestibular schwannomas (VSs), which make up 8% of all intracranial tumors, [2][3][4] is gross total resection. 5 However, a common complication of VS resection is damage caused to the facial nerve during surgery.…”

Giant vestibular schwannomas: Surgical nuances influencing outcome in 179 patients

“…[8] Not only is there an impact on audio-facial morbidity, but also the effect on quality of life cannot be overemphasized. [9] While there are only a few studies that discuss the outcomes and technical surgical nuances specific to giant VSs (>4 cm in size), [5,[10][11][12][13] to our knowledge, there is no comparison within this group with a larger subset of tumors that are >5 cm in size available in the English literature.…”

Isolated hemimegalencephaly in an adult

“…HME is a severe developmental malformation of the brain, remarkable for its extreme asymmetry. [1] Localized megalencephaly accounts for one quarter of all HME cases and predominantly seen on the left side (72.7%). [2] It is divided into three forms: (1) Isolated form, most common (66%); (2) syndromic form associated with several neurocutaneous syndromes; and (3) total HME, less common.…”

“…[2] It is divided into three forms: (1) Isolated form, most common (66%); (2) syndromic form associated with several neurocutaneous syndromes; and (3) total HME, less common. [1] The classic neurological triad includes intractable seizures with onset typically within the first few months of life is the most common presenting symptom, contralateral hemiparesis, and severe psychomotor delays. [1,2] Causes of HME may be related to insults as early as the third week of gestation.…”