Translabyrinthine microsurgical resection of small vestibular schwannomas

Abstract

OBJECTIVE Translabyrinthine resection is one of a number of treatment options available to patients with vestibular schwannomas. Though this procedure is hearing destructive, the authors have noted excellent clinical outcomes for patients with small tumors. The authors review their experience at a tertiary acoustic neuroma referral center in using the translabyrinthine approach to resect small vestibular schwannomas. All operations were performed by a surgical team consisting of a single neurosurgeon and 1 of 7 neurotologists. METHODS Data from a prospectively maintained clinical database were extracted and reviewed. Consecutive patients with a preoperative diagnosis of vestibular schwannoma that had less than 1 cm of extension into the cerebellopontine angle, operated on between 2008 and 2013, were included. Patents with neurofibromatosis Type 2, previous treatment, or preexisting facial weakness were excluded. In total, 107 patients were identified, 74.7% of whom had poor hearing preoperatively. RESULTS Pathologically, 6.5% of patients were found to have a tumor other than vestibular schwannoma. Excluding two malignancies, the tumor control rates were 98.7%, as defined by absence of radiographic disease, and 99.0%, as defined by no need for additional treatment. Facial nerve outcome was normal (House-Brackmann Grade I) in 97.2% of patients and good (House-Brackmann Grade I-II) in 99.1%. Complications were cerebrospinal fluid leak (4.7%) and sigmoid sinus thrombosis (0.9%), none of which led to long-term sequelae. CONCLUSIONS Translabyrinthine resection of small vestibular schwannomas provides excellent results in terms of complication avoidance, tumor control, and facial nerve outcomes. This is a hearing-destructive operation that is advocated for selected patients.

Stereotactic radiosurgery as the first-line treatment for intracanalicular vestibular schwannomas

“…The tumor control rates 1 year after microsurgical resection of intracanalicular VSs also range from 98.7% to 100%. [26][27][28] Long-term recurrence rates await further analyses. After surgical removal of all Koos grade tumors, Nakatomi et al reported estimated recurrence-free survival rates of 93% at 5 years, 78% at 10 years, and 68% at 15 years.…”

“…30 Zhu et al reported a 4-year serviceable hearing preservation rate of 47.1% after microsurgical resection. 27 In view of the wide variability of complications reported after resection (0%-27% for facial palsy, 0%-27% for CSF leakage, and 0%-16% for brain edema [26][27][28]30,31 ), we believe that radiosurgery remains an important option that educated patients can choose after they evaluate the pros and cons that pertain to their own goals and concerns.…”

Clinical Application of Augmented Reality in Computerized Skull Base Surgery

“…This constituency requires extremely high-contrast tools and careful interaction. Sensory specialists break through the rock walls under meticulous reinforcement mechanisms, revealing actual development layer by layer and their progress into the cerebellar point and intracranial space of the pyramidal space [ 30 ]. However, the magnified focus provides a three-dimensional picture of the field, course, and bearing.…”

Gamma knife surgery in the treatment of intracanalicular vestibular schwannomas

“…[7][8][9][10] Microsurgical resection of IVS should be considered when the tumor growth is confirmed at a rate of more than 2-3 mm per year, however this depends on the size of tumor at the time of treatment, hearing level, age and also co-morbidities. 11 Depending on the surgical approach, hearing preservation rates after microsurgical resection range from 0% to 75%, 2,4,[12][13][14][15][16][17][18] whereas facial nerve function preservation rates are generally excellent, up to 100% according to some authors. GKS is widely used in the treatment of IVS.…”