The Learning Curve for Surgical Resection of Vestibular Schwannoma

Extrapulmonary small cell carcinomas (EPSCC) are rare malignancies with poor patient prognoses. We present the case of a 63-year-old male who underwent surgical resection of a poorly differentiated small cell carcinoma, likely from a small intestinal primary tumor that metastasized to the cerebellopontine angle (CPA). A 63-year-old male presented with mild left facial paralysis, hearing loss, and balance instability. MRI revealed a 15 mm mass in the left CPA involving the internal auditory canal consistent with a vestibular schwannoma. Preoperative MRI eight weeks later demonstrated marked enlargement to 35 mm. The patient underwent a suboccipital craniectomy and the mass was grossly different visually and in consistency from a standard vestibular schwannoma. The final pathology revealed a poorly differentiated small cell carcinoma. Postoperative PET scan identified avid uptake in the small intestine suggestive of either a small intestinal primary tumor or additional metastatic disease. The patient underwent whole brain radiation therapy and chemotherapy and at last follow-up demonstrated improvement in his symptoms. Surgical resection and radiotherapy are potential treatment options to improve survival in patients diagnosed with NET brain metastases. We present the first documented case of skull base metastasis of a poorly differentiated small cell carcinoma involving the CPA.

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The learning curve in post-operative hearing results in vestibular schwannoma surgery

Auris Nasus Larynx ◽

10.1016/s0385-8146(01)00086-4 ◽

2001 ◽

Vol 28 (3) ◽

pp. 209-213 ◽

Cited By ~ 7

Author(s):

Jin Kanzaki ◽

Yasuhiro Inoue ◽

Kaoru Ogawa

Keyword(s):

Learning Curve ◽

Vestibular Schwannoma ◽

Hearing Results

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Intracranial angiosarcoma arising from a schwannoma

The Journal of Laryngology & Otology ◽

10.1017/s0022215106003070 ◽

2006 ◽

Vol 121 (1) ◽

pp. 68-71 ◽

Cited By ~ 7

Author(s):

T Ito ◽

T Tsutsumi ◽

K Ohno ◽

T Takizawa ◽

K Kitamura

Keyword(s):

Surgical Resection ◽

Vestibular Schwannoma ◽

Histological Diagnosis ◽

Review Of The Literature ◽

First Report ◽

Cd34 Antigen ◽

S 100 ◽

Base Of The Skull

Angiosarcomas rarely arise from schwannomas, but we describe here a case of angiosarcoma that arose from a remnant of a benign vestibular schwannoma that had been removed 10 years earlier. The patient was a 66-year-old man with no sign of neurofibromatosis. Although we attempted surgical resection, we could not totally remove the tumour. The patient died nine months after diagnosis, primarily as result of an abscess in the cerebellum and base of the skull. The histological diagnosis was confirmed by the immunohistochemical findings of positivity for CD34 antigen and S-100 protein in the resected tumour.A review of the literature revealed four other cases of angiosarcoma with schwannoma, all of which arose from an extracranial nerve. The present case is the first report of an angiosarcoma with schwannoma arising from an intracranial locus.

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Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1725032 ◽

2021 ◽

Author(s):

Marte van Keulen ◽

Jonathan Pace ◽

Christopher J. Burant ◽

David L. Penn ◽

Betsy Wilson ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Resection ◽

Vestibular Schwannoma ◽

Clinical Evidence ◽

Tumor Resection ◽

Case Series ◽

Rare Presentation ◽

Visual Symptoms ◽

Younger Age ◽

Csf Diversion

Abstract Introduction The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes. Objective The study aimed to evaluate the surgical management of vestibular schwannoma at a single institution and to identify factors that may contribute to hydrocephalus, papilledema, and the need for pre-resection diversion of cerebrospinal fluid. Patients and Methods A retrospective review examining the data of 203 patients with vestibular schwannoma managed with surgical resection from May 2008 to May 2020. We stratified patients into five different groups to analyze: tumors with a diameter of ≥40 mm, clinical evidence of hydrocephalus, and of papilledema, and patients who underwent pre-resection cerebrospinal fluid (CSF) diversion. Results From May 2008 to May 2020, 203 patients were treated with surgical resection. Patients with tumors ≥40 mm were more likely to present with visual symptoms (p < 0.001). Presentation with hydrocephalus was associated with larger tumor size (p < 0.001) as well as concomitant visual symptoms and papilledema (p < 0.001). Patients with visual symptoms presented at a younger age (p = 0.002) and with larger tumors (p < 0.001). Conclusion This case series highlights the rare presentation of vision changes and hydrocephalus in patients with vestibular schwannoma. We recommend urgent CSF diversion for patients with visual symptoms and hydrocephalus, followed by definitive resection. Further, vision may still deteriorate even after CSF diversion and tumor resection.

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Vestibular schwannoma management

Journal of Neurosurgery ◽

10.3171/jns.1998.89.6.0949 ◽

1998 ◽

Vol 89 (6) ◽

pp. 949-955 ◽

Cited By ~ 95

Author(s):

Bruce E. Pollock ◽

L. Dade Lunsford ◽

Douglas Kondziolka ◽

Raymond Sekula ◽

Brian R. Subach ◽

...

Keyword(s):

Tumor Growth ◽

Surgical Resection ◽

Vestibular Schwannoma ◽

Tumor Resection ◽

Gamma Knife Radiosurgery ◽

Gross Total Resection ◽

Total Resection ◽

Content Type ◽

Tumor Enlargement ◽

Fine Print

Object. The indications, operative findings, and outcomes of vestibular schwannoma microsurgery are controversial when it is performed after stereotactic radiosurgery. To address these issues, the authors reviewed the experience at two academic medical centers. Methods. During a 10-year interval, 452 patients with unilateral vestibular schwannomas underwent gamma knife radiosurgery. Thirteen patients (2.9%) underwent delayed microsurgery at a median of 27 months (range 7–72 months) after they had undergone radiosurgery. Six of the 13 patients had undergone one or more microsurgical procedures before they underwent radiosurgery. The indications for surgery were tumor enlargement with stable symptoms in five patients, tumor enlargement with new or increased symptoms in five patients, and increased symptoms without evidence of tumor growth in three patients. Gross-total resection was achieved in seven patients and near-gross-total resection in four patients. The surgery was described as more difficult than that typically performed for schwannoma in eight patients, no different in four patients, and easier in one patient. At the last follow-up evaluation, three patients had normal or near-normal facial function, three patients had moderate facial dysfunction, and seven had facial palsies. Three patients were incapable of caring for themselves, and one patient died of progression of a malignant triton tumor. Conclusions. Failed radiosurgery in cases of vestibular schwannoma was rare. No clear relationship was demonstrated between the use of radiosurgery and the subsequent ease or difficulty of delayed microsurgery. Because some patients have temporary enlargement of their tumor after radiosurgery, the need for surgical resection after radiosurgery should be reviewed with the neurosurgeon who performed the radiosurgery and should be delayed until sustained tumor growth is confirmed. A subtotal tumor resection should be considered for patients who require surgical resection of their tumor after vestibular schwannoma radiosurgery.

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Management of jugular bulb injury during retrosigmoid transmeatal resection of vestibular schwannoma

Neurosurgical Focus: Video ◽

10.3171/2021.7.focvid2155 ◽

2021 ◽

Vol 5 (2) ◽

pp. V5

Author(s):

Felipe Constanzo ◽

Bernardo Correa de Almeida Teixeira ◽

Mauricio Coelho Neto ◽

Ricardo Ramina

Keyword(s):

Surgical Resection ◽

Vestibular Schwannoma ◽

Internal Auditory Canal ◽

Standard Technique ◽

Jugular Bulb ◽

Vestibular Schwannomas ◽

Link Type

Inadvertent laceration of the jugular bulb is a potentially serious complication of the retrosigmoid transmeatal approach to vestibular schwannomas. Here, the authors present the case of a 51-year-old woman with a right Hannover T4a vestibular schwannoma and bilateral high-riding jugular bulb, which was opened during drilling of the internal auditory canal (IAC). They highlight the immediate management of this complication, technical nuances for closing the defect without occluding the jugular bulb, and modifications of the standard technique needed to continue surgical resection. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2155

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