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Surgical management of vestibular schwannoma: attempted preservation of hearing and facial function

Published online by Cambridge University Press:  03 April 2013

T F Youssef ,
A Matter  and
M R Ahmed
T F Youssef
Affiliation:
Faculty of Medicine, Suez Canal University, Ismailia, Egypt
A Matter
Affiliation:
Faculty of Medicine, Suez Canal University, Ismailia, Egypt
M R Ahmed*
Affiliation:
Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*
Address for correspondence: Dr M R Ahmed, Lecturer in Otolaryngology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt Fax: +20 66 3415603 E-mail: M_rifaat@hotmail.com
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Abstract

Background:

Vestibular schwannomas are benign tumours which usually originate from the vestibular portion of the VIIIth cranial nerve. Treatment options include observation with serial imaging, stereotactic radiation and microsurgical removal.

Aim:

The goal of surgery was complete eradication of tumour with preservation of hearing and facial nerve function.

Methods:

A retrospective review was undertaken of 24 cases of vestibular schwannoma jointly operated upon by a team of neurosurgeons and otologists at the Suez Canal University Hospital, with assessment of VIIth and VIIIth cranial nerve function, tumour size, and extent of growth. All surgery utilised a retromastoid, suboccipital approach.

Results:

Complete tumour removal was achieved in 19 patients. Anatomical preservation of the facial nerve was possible in 66.6 per cent of patients. Pre-operative, useful hearing was present in four patients, and preserved in 80 per cent. Cerebrospinal fluid leakage was diagnosed in two (8.3 per cent) patients, who responded to conservative therapy.

Conclusion:

The retromastoid, suboccipital surgical approach to the skull base can be safely and successfully achieved using a microsurgical technique, with minimal or no damage to neurovascular structures, even for large tumours.

Keywords

NeuromaAcousticHearing LossOtologic Surgical ProceduresEgyptFacial NerveComplications
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 5 , May 2013 , pp. 473 - 478
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Andersen, HT, Schrøder, SA, Bonding, P. Unilateral deafness after acoustic neuroma surgery: subjective hearing handicap and the effect of the bone-anchored hearing aid. Otol Neurotol 2006;27:809–14CrossRefGoogle ScholarPubMed
2Lin, D, Hegarty, JL, Fischbein, NJ, Jackler, RK. The prevalence of “incidental” acoustic neuroma. Arch Otolaryngol Head Neck Surg 2005;131:241–4CrossRefGoogle ScholarPubMed
3McLeod, B, Upfold, L, Taylor, A. Self reported hearing difficulties following excision of vestibular schwannoma. Int J Audiol 2008;47:420–30CrossRefGoogle ScholarPubMed
4Hansen, MR, Clark, JJ, Gantz, BJ, Goswami, PC. Effects of ErbB2 signaling on the response of vestibular schwannoma cells to gamma-irradiation. Laryngoscope 2008;118:1023–30CrossRefGoogle ScholarPubMed
5Chopra, R, Kondziolka, D, Niranjan, A, Lunsford, LD, Flickinger, JC. Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 2007;68:845–51CrossRefGoogle Scholar
6Koerbel, A, Gharabaghi, A, Safavi-Abbasi, Tatagiba, M, Samii, M. Evolution of vestibular schwannoma surgery: the long journey to current success. Neurosurg Focus 2005;18:e10CrossRefGoogle Scholar
7Nayak, PK, Kumar, R. Retromastoid-sub occipital: a novel approach to cerebello pontine angle in acoustic neuroma surgery – our experience in 21 cases. J Neurosci Rural Pract 2011;2:23–6Google ScholarPubMed
8Yang, SM, Yu, LM, Han, DY. Technique of hearing preservation during acoustic neuroma surgery [in Chinese]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008;43:564–9Google ScholarPubMed
9Misra, BK, Purandare, HR, Ved, RS, Bagdia, AA, Mare, PB. Current treatment strategy in the management of vestibular schwannoma. Neurol India 2009;57:257–63CrossRefGoogle ScholarPubMed
10Timmer, FC, Graamans, K. A large vestibular schwannoma that did not grow for 18 years. B-ENT 2011;7:305–7Google ScholarPubMed
11House, JW, Brackmann, DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146–7CrossRefGoogle ScholarPubMed
12Gardner, G, Robertson, JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol 1988;97:55–66CrossRefGoogle ScholarPubMed
13Kim, E, Nam, SI. Staging in vestibular schwannoma surgery: a modified technique. J Korean Neurosurg Soc 2008;43:57–60CrossRefGoogle ScholarPubMed
14Yamakami, I, Uchino, Y, Kobayashi, E, Yamaura, A, Oka, N. Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neurol Neurosurg Psychiatry 2004;75:453–8CrossRefGoogle ScholarPubMed
15Cohen, NL. Acoustic neuroma surgery with emphasis on preservation of hearing. Laryngoscope 1979;89:886–96CrossRefGoogle ScholarPubMed
16Glasscock, ME, Hays, JW, Minor, LB, Haynes, DS, Carrasco, VN. Preservation of hearing in surgery for acoustic neuromas. J Neurosurg 1993;78:864–70CrossRefGoogle Scholar
17Mazzoni, A, Calabrese, V, Danesi, G, De Nigris, M. The suboccipital approach in functional surgery of acoustic neuroma [in Italian]. Acta Otorhinolaryngol Ital 1993;13:3–11Google ScholarPubMed
18Sampath, P, Rini, D, Long, DM. Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases. J Neurosurg 2000;92:70–8CrossRefGoogle ScholarPubMed
19Bentivoglio, P, Cheesman, AD, Symon, L. Surgical treatment of acoustic neuromas during the last five years: part II – results for facial and cochlear nerve function. Surg Neurol 1988;29:205–9CrossRefGoogle ScholarPubMed
20Kondziolka, D, Lunsford, LD, Flickinger, JC. Comparison of management options for patients with acoustic neuromas. Neurosurg Focus 2003;14:e1CrossRefGoogle ScholarPubMed
21Torrens, M, Maw, R, Coakham, H, Butler, S, Morgan, H. Facial and acoustic nerve preservation during excision of extracanalicular acoustic neuromas using the suboccipital approach. Br J Neurosurg 1994;8:655–65CrossRefGoogle ScholarPubMed
22Kurokawa, Y, Uede, T, Ohtaki, M, Tanabe, S, Hashi, K. Hearing preservation and tinnitus following removal of acoustic neurinomas [in Japanese]. No Shinkei Geka 1996;24:329–34Google ScholarPubMed
23Anderson, DE, Leonetti, J, Wind, JJ, Cribari, D, Fahey, K. Resection of large vestibular schwannoma: facial nerve preservation in the context of surgical approach and patient-assessed outcome. J Neurosurg 2005;102:643–9CrossRefGoogle ScholarPubMed
24Betchen, SA, Walsh, J, Post, KD. Long-term hearing preservation after surgery of vestibular schwannoma. J Neurosurg 2005;102:6–9CrossRefGoogle ScholarPubMed