Surgical treatment of patients with vestibular schwannomas after failed previous radiosurgery

Gerganov, Venelin M.; Giordano, Mario; Samii, Amir; Samii, M.

doi:10.3171/2011.12.jns111682

Cited by 48 publications

(42 citation statements)

References 43 publications

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“…[32] The postoperative facial nerve function is indeed worse than in untreated VS of similar size and the risk of new neurological deficits or CSF leak tended to be higher. However, the differences were not significant.…”

Section: Surgery After Failed Radiosurgerymentioning

confidence: 97%

“…[29][30][31] Surgery is indicated in patients with large tumors compressing the brainstem, in case of sustained tumor growth, which is documented on serial MR examinations or in case of progression of symptoms. [32] Surgery after failed radiosurgery is more complex and challenging due to the development of extensive postradiational changes. [29,31] Still, its goal should be compete tumor removal.…”

Section: Surgery After Failed Radiosurgerymentioning

confidence: 99%

“…[29,31] Still, its goal should be compete tumor removal. [32] It is difficult to assume that a remnant of VS that expanded despite the previous therapy will change its biological behavior and stop growing. As recommended by some authors, partial removal [31,33] may indeed lead to better functional outcome in some cases; but it is a short-term solution.…”

Section: Surgery After Failed Radiosurgerymentioning

confidence: 99%

“…[32] The major challenges are the dissection of tumor capsule from cranial nerves or brainstem due to the tight adherence or lack of clear arachnoid plane; the increased vulnerability of the facial nerve; and the radiation-induced vasculopathy with the related tendency for delayed rupture and bleeding.…”

Section: Surgery After Failed Radiosurgerymentioning

confidence: 99%

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Surgery of vestibular schwannomas

Samii¹,

Samii²,

Gerganov³

2012

IJNS

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A B S T R A C TVestibular schwannomas (VS) are the most common tumors of the cerebellopontine angle (CPA). Their surgical management has reached high standards in the last decade. Treatment options for VS are microsurgical removal or Radiosurgery. The following three basic operative approaches are currently utilized: Retrosigmoid approach (RSA), translabyrinthine and middle fossa approach. The following article elaborates the operative technique by the senior author based on his vast experience of VS surgery formed over the last three decades; during which period he has operated more than 3500 of such patients

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Section: Surgery After Failed Radiosurgerymentioning

confidence: 97%

Section: Surgery After Failed Radiosurgerymentioning

confidence: 99%

Section: Surgery After Failed Radiosurgerymentioning

confidence: 99%

Section: Surgery After Failed Radiosurgerymentioning

confidence: 99%

See 2 more Smart Citations

Surgery of vestibular schwannomas

Samii¹,

Samii²,

Gerganov³

2012

IJNS

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“…What is the destiny of the failures of radiotherapy, that is the 'rescue surgery' contemplated in radiotherapy's therapeutic plans? Several studies [2][3][4] agree that surgical removal is more difficult because of the scar tissue and the fragility of the 7th cranial nerve, with significant rates of 7th nerve palsy, incomplete removal and other complications. It must be taken into account that the preservative nature of radiotherapy and clinical observation bears some limitations that we need to be aware of.…”

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confidence: 99%

Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach as a minimally invasive surgical option for the treatment of medium to large vestibular schwannoma

2013

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The paper from Iacoangeli and his colleagues from Ancona and Rome in this issue of Acta Neurochirurgica is timely given the continuing controversy on best treatment options for vestibular schwannomas.Their report is on the preliminary experience with an old approach integrated with the endoscope. The case material includes ten cases of small and medium sized sporadic acoustic neuromas (five cases of 8 and 10 mm, five cases of 11-25 mm), selected on the basis of a favourable anatomy of the temporal bone.It is noteworthy, and rather exceptional in comparison to other's experiences, that only three cases out of ten had a preoperative normal facial nerve function, while four cases of 11-25 mm had a House-Brackmann (HB) grade 3 and three cases of 10 and 20 mm had a HB grade 2, which makes 70 % of preoperative facial dysfunction in small and medium-size tumors.The surgical outcome was outstanding, with unchanged postoperative facial function (with the exception of the case with preoperative radiotherapy), only one case experiencing a hearing loss from AAORLHNS class B to C, and no instances of deafness. The removal of tumors from the internal auditory canal without a drill meatotomy in this series might have been favoured by a limited extension into the canal. The results on the hearing and facial nerve are superior to the results reported in the literature.We dare to say that we never had a group of ten consecutive cases with only one postop limited hearing loss in over 300 cases of hearing preservation surgery on smaller tumors [8].This revived approach, which was already dismissed by experienced surgeons, although now implemented by endoscopic assistance needs further validation in order to assess its performance versus the standard retrosigmoid approach.Notwithstanding, Iacoangeli and his colleagues have further contributed to the debate upon the treatment of acoustic neuroma. This has indeed been an active dispute over the last decades, and is nowadays even keener thanks to the further inputs brought by neurosurgeons, otosurgeons, endoscopists, and, last but not least, radiotherapists.It should be considered that early diagnosis results in a patient's population mainly (in 70 % of cases, according to accredited studies) made up of small tumors: the current debate and renewal of treatment options is therefore nowadays addressed to such lesions.

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