Vestibular Schwannoma Surgery Outcomes: Our Multidisciplinary Experience in 400 Cases Over 17 Years

Darrouzet, V.; Martel, J.; Enee, Véronique; Bébéar, J. P.; Guérin, J.

doi:10.1097/00005537-200404000-00016

Cited by 211 publications

(145 citation statements)

References 26 publications

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“…11,75 Frequently cited predictors of facial nerve function include tumor size, surgical approach, and the use of intraoperative monitoring. 15,22,40,64,75 The length of contact of the tumor with the nerve has also been suggested as a potential prognostic factor. 18 Samii et al 74 believe that prior surgery or radiosurgery and the presence of an intratumoral cyst are negative predictors of postoperative facial nerve function.…”

Section: Facial Nerve Functionmentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

250

225

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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Section: Facial Nerve Functionmentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

250

225

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“…In two other large series, Sindou et al [6] and Knosp et al [7] reported a trigeminal and visual cranial nerve deficit incidence of between 14 and 58%. Similarly, even with microsurgical resection with intra-operative monitoring, facial nerve dysfunction occurs in up to 7% of patients [26][27][28][29] and hearing loss is universally observed in most acoustic neuromas exceeding 2-3 cm in diameter [30][31][32]. Hence, radiation therapy has been a preferred choice for such tumors with preserved neurological function.…”

Section: Hypofractionatedmentioning

confidence: 99%

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Mahadevan¹,

Floyd²,

Wong

et al. 2011

Computer Aided Surgery

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“…They are usually found in the central nervous system, spinal cord, or peripheral nerves of the body, with the most common type being acoustic neuroma. 7 Occasionally, schwannomas occur in the gastrointestinal tract. Together with leiomyoma, leiomyosarcoma, and gastrointestinal stromal tumors (GIST), they constitute mesenchymal tumors of the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Schwannomas: Case Report With Literature Review

Shelat

Naik

et al. 2013

International Surgery

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Schwannomas are rare tumors that arise from Schwann cells in neural sheaths. They are commonly found in the central nervous system, spinal cord, or peripheral nerves of the body. Occasionally, they occur in the gastrointestinal tract, with the stomach being the most common site. However, colorectal and retroperitoneal schwannomas are very rare. Preoperative diagnosis is often difficult and definitive treatment entails surgical excision. We herein present 3 cases of intraabdominal schwannomas.

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Vestibular Schwannoma Surgery Outcomes: Our Multidisciplinary Experience in 400 Cases Over 17 Years

Abstract: Transpetrosal approaches (translabyrinthine, widened retrolabyrinthine) are safe for vestibular schwannoma removal, and rates of postoperative complications and sequelae are decreasing.

Cited by 211 publications

References 26 publications

Surgery for vestibular schwannomas: a systematic review of complications by approach

Surgery for vestibular schwannomas: a systematic review of complications by approach

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Abdominal Schwannomas: Case Report With Literature Review

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