scholarly journals Staging in giant vestibular schwannoma surgery: A two consecutive day technique for complete resection in basic neurosurgical setups

2014 ◽  
Vol 05 (03) ◽  
pp. 225-230
Author(s):  
Deepak Bandlish ◽  
Nilay Biswas ◽  
Sumit Deb
Keyword(s):  
Vestibular Schwannoma ◽  
Complete Resection ◽  
Vestibular Schwannomas ◽  
Karnofsky Performance Score ◽  
Duration Of Symptoms ◽  
Lower Cranial Nerve ◽  
Nerve Monitoring ◽  
Ultrasonic Aspirator ◽  
Maximal Diameter ◽  
Ventriculoperitoneal Shunting

ABSTRACT Introduction: Vestibular schwannomas constitute 8% of all intracranial tumors. A majority of vestibular schwannomas are sporadic and unilateral. Giant vestibular schwannomas are seen in our country due to the late diagnosis and long duration of symptoms before diagnosis. These giant schwannomas are challenging to manage as most of the patients are having brainstem compression. Materials and Methods: Twelve cases of a giant vestibular schwannoma were operated in our department between May 2011 and December 2012. Vestibular schwannomas with a maximal diameter of more than 4 cm were defined as a giant vestibular schwannoma. All the patients had a unilateral vestibular schwannoma. Performance status of all the patients were graded as per the Karnofsky performance score. Pre-operative assessment of 5th, 7th, 8th and lower cranial nerve status was done in all cases. Ventriculoperitoneal shunting was done pre-operatively in all cases. All patients were operated through retromastoid suboccipital craniectomy and retrosigmoid approach. These patients were operated in two stages in two consecutive days with overnight elective ventilation in ICU. Ultrasonic aspirator and nerve monitoring techniques were not used. Results: Giant acoustic schwannomas can be safely resected completely by a staged resection on two consecutive days without any increased morbidity or mortality. This technique may be employed to achieve complete resection of such lesions without deterioration of facial nerve function in institutions which do not have advanced facilities like nerve monitoring or ultrasonic aspirator.

Contemporary Surgical Management of Vestibular Schwannomas: Analysis of Complications and Lessons Learned Over the Past Decade

2012 ◽  
Vol 72 (2) ◽  
pp. ons103-ons115 ◽  
Author(s):  
Yoichi Nonaka ◽  
Takanori Fukushima ◽  
Kentaro Watanabe ◽  
Allan H. Friedman ◽  
John H. Sampson ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Clinical Status ◽  
Neurological Complication ◽  
Tumor Resection ◽  
Hearing Preservation ◽  
Lessons Learned ◽  
Vestibular Schwannomas ◽  
Consecutive Series ◽  
Lower Cranial Nerve

Abstract BACKGROUND: Despite advanced microsurgical techniques, more refined instrumentation, and expert team management, there is still a significant incidence of complications in vestibular schwannoma surgery. OBJECTIVE: To analyze complications from the microsurgical treatment of vestibular schwannoma by an expert surgical team and to propose strategies for minimizing such complications. METHODS: Surgical outcomes and complications were evaluated in a consecutive series of 410 unilateral vestibular schwannomas treated from 2000 to 2009. Clinical status and complications were assessed postoperatively (within 7 days) and at the time of follow-up (range, 1–116 months; mean, 32.7 months). RESULTS: Follow-up data were available for 357 of the 410 patients (87.1%). Microsurgical tumor resection was performed through a retrosigmoid approach in 70.7% of cases. Thirty-three patients (8%) had intrameatal tumors and 204 (49.8%) had tumors that were <20 mm. Gross total resection was performed in 306 patients (74.6%). Hearing preservation surgery was attempted in 170 patients with tumors <20 mm, and good hearing was preserved in 74.1%. The main neurological complication was facial palsy (House-Brackmann grade III-VI), observed in 14% of patients (56 cases) postoperatively; however, 59% of them improved during the follow-up period. Other neurological complications were disequilibrium in 6.3%, facial numbness in 2.2%, and lower cranial nerve deficit in 0.5%. Nonneurological complications included cerebrospinal fluid leaks in 7.6%, wound infection in 2.2%, and meningitis in 1.7%. CONCLUSION: Many of these complications are avoidable through further refinement of operative technique, and strategies for avoiding complications are proposed.

scholarly journals Facial Nerve Preservation and Surgical Outcomes of Retrosigmoid Approach to Large Vestibular Schwannoma- an Eight-year Single Institution Experience

2017 ◽  
Vol 14 (3) ◽  
pp. 19-25
Author(s):  
Pratyush Shrestha ◽  
Nisha Kutu ◽  
Subash Lohani ◽  
Upendra Prasad Devkota
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Tumor Size ◽  
Statistical Significance ◽  
Retrosigmoid Approach ◽  
Vestibular Schwannomas ◽  
P Value ◽  
Exact Test ◽  
Nerve Preservation ◽  
Ventriculoperitoneal Shunting

Objective: To evaluate the result of microsurgical excision of vestibular schwannoma by retrosigmoid approach and to correlate the facial nerve outcome with the tumor size.Methods: Retrospective analysis of 84 patients with cerebello-pontine angle lesions (57 vestibular schwannomas) operated at National Institute of Neurological and Allied Sciences, Nepal, from Baisakh 2066 to Chaitra 2073 (eight years). Facial nerve outcomes as per the House and Brackmann grading at six months follow-up were recorded and correlated with tumor size.Result: The mean tumor size was 4.32 ± 1.23 cms and 48 (84.2%) of the patients had tumor size more than 3 cms. Patients presented late with papilloedema documented in 42.1% and preoperative ventriculoperitoneal shunting required in 31.57% patients. Of the patients whose facial nerve functions could be followed up, all patients with tumors < 3cm diameter had good House and Brackmann facial nerve outcome (grade I to III). Larger tumors had poorer facial nerve outcomes; however statistical significance could not be reached. (Fischer Exact test, p-value: 0.077). There were two mortalities (3.5%), one following cavity rebleed and one following malignant brain swelling.Conclusion: Retrosigmoid approach is a versatile surgical corridor to excise large vestibular schwannomas with minimal complications and larger tumors have poorer facial nerve outcomes. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, Page: 19-25

Developing Intraoperative Cochlear Nerve Monitoring during Vestibular Schwannoma Surgery

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
A. Kasbekar ◽  
Y. Tam ◽  
R. Carlyon ◽  
J. Deeks ◽  
N. Donnelly ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Monitoring

Cerebellopontine Angle Surgery Assisted by Continuous Mapping of the Facial Nerve Via the Ultrasonic Aspirator

2020 ◽  
Author(s):  
Marco Cenzato ◽  
Roberto Stefini ◽  
Francesco Zenga ◽  
Maurizio Piparo ◽  
Alberto Debernardi ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Continuous Mapping ◽  
Cost Effective ◽  
Current Intensity ◽  
Vestibular Schwannomas ◽  
Constant Current ◽  
Surgical Workflow ◽  
Ultrasonic Aspirator

Abstract Background Cerebellopontine angle (CPA) surgery carries the risk of lesioning the facial nerve. The goal of preserving the integrity of the facial nerve is usually pursued with intermittent electrical stimulation using a handheld probe that is alternated with the resection. We report our experience with continuous electrical stimulation delivered via the ultrasonic aspirator (UA) used for the resection of a series of vestibular schwannomas. Methods A total of 17 patients with vestibular schwannomas, operated on between 2010 and 2018, were included in this study. A constant-current stimulator was coupled to the UA used for the resection, delivering square-wave pulses throughout the resection. The muscle responses from upper and lower face muscles triggered by the electrical stimulation were displayed continuously on multichannel neurophysiologic equipment. The careful titration of the electrical stimulation delivered through the UA while tapering the current intensity with the progression of the resection was used as the main strategy. Results All operations were performed successfully, and facial nerve conduction was maintained in all patients except one, in whom a permanent lesion of the facial nerve followed a miscommunication to the neurosurgeon. Conclusion The coupling of the electrical stimulation to the UA provided the neurosurgeon with an efficient and cost-effective tool and allowed a safe resection. Positive responses were obtained from the facial muscles with low current intensity (lowest intensity: 0.1 mA). The availability of a resection tool paired with a stimulator allowed the surgeon to improve the surgical workflow because fewer interruptions were necessary to stimulate the facial nerve via a handheld probe.

Spreading of the vestibular schwannoma into porus acusticus internus. Endoscopic removal possibilities

2018 ◽  
pp. 40-44
Author(s):  
Orest Palamar ◽  
Andriy Huk ◽  
Dmytro Okonskyi ◽  
Ruslan Aksyonov ◽  
Dmytro Teslenko
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Residual Tumor ◽  
Endoscopic Technique ◽  
Vestibular Schwannomas ◽  
Endoscopic Removal ◽  
Tumor Removal ◽  
Tumor Spread ◽  
Microsurgical Technique ◽  
Tumor Visualization

Aim: To investigate the features of the vestibular schwannoma spread into the internal auditory canal and the possibilities of endoscopic removal. Objectives: To improve tumor visualization in the internal auditory canal; to create a sufficient view angle for tumor removal during endoscopic opening of the internal auditory canal. Materials and methods: The results of surgical treatment of 20 patients with vestibular schwannomas in which the tumor spread to the internal auditory canal were analyzed. Microsurgical tumor removal was performed in 14 cases; Fully endoscopic removal of vestibular schwannomas was performed in 6 cases. The internal auditory canal opening was performed in 14 cases using microsurgical technique and in 6 cases with fully the endoscopic technique. Results: Gross total removal was achieved in 18 cases, subtotal removal in 2 cases. The tumor spread into the internal auditory canal was removed in all cases (100%). Opening the internal auditory canal using the endoscopic technique allows to increase the view angle (up to 20%) and to visualize along the axis of canal. Conclusions: 1) Endoscopic assistance technique allows to improve residual tumor visualization much more better then microsurgical technique; 2) Internal auditory canal opening using endoscopic technique is much more effective than the microsurgical technique (trepanning depth is larger); 3) Endoscopic methods for the internal auditory canal opening allows to increase canal angle view up to 20% (comparing to the microsurgical view).

scholarly journals Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

2021 ◽  
Author(s):  
Nicolas Bovo ◽  
Shahan Momjian ◽  
Renato Gondar ◽  
Philippe Bijlenga ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Evoked Potentials ◽  
Negative Predictive Value ◽  
Patient Group ◽  
Vestibular Schwannoma ◽  
Predictive Value ◽  
Cerebellopontine Angle ◽  
Motor Evoked Potentials ◽  
Vestibular Schwannomas ◽  
Predictive Values

Abstract Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

scholarly journals Diamond knife dissection technique for nerve preservation during resection of large vestibular schwannomas

2021 ◽  
Vol 5 (2) ◽  
pp. V8
Author(s):  
Julia Shawarba ◽  
Cand Med ◽  
Matthias Tomschik ◽  
Karl Roessler
Keyword(s):  
Vestibular Schwannoma ◽  
Facial Nerve Palsy ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Dissection Techniques ◽  
Dissection Technique ◽  
Large Vestibular Schwannoma ◽  
Facial Function ◽  
Diamond Knife

Facial and cochlear nerve preservation in large vestibular schwannomas is a major challenge. Bimanual pincers or plate-knife dissection techniques have been described as crucial for nerve preservation. The authors demonstrate a recently applied diamond knife dissection technique to peel the nerves from the tumor capsule. This technique minimizes the nerve trauma significantly, and complete resection of a large vestibular schwannoma without any facial nerve palsy and hearing preservation is possible. The authors illustrate this technique during surgery of a 2.6-cm vestibular schwannoma in a 27-year-old male patient resulting in normal facial function and preserved hearing postoperatively. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21104

scholarly journals Hemorrhagic vestibular schwannoma: an unusual clinical entity

1998 ◽  
Vol 5 (3) ◽  
pp. E14 ◽  
Author(s):  
Dean Chou ◽  
Prakash Sampath ◽  
Henry Brem
Keyword(s):  
Vestibular Schwannoma ◽  
Cranial Nerve ◽  
Unusual Case ◽  
Case Reports ◽  
Clinical Entity ◽  
Vestibular Schwannomas ◽  
Presenting Symptoms ◽  
Cranial Nerve Dysfunction ◽  
Nerve Dysfunction ◽  
Management Issues

Hemorrhagic vestibular schwannomas are rare entities, with only a few case reports in the literature during the last 25 years. The authors review the literature on vestibular schwannoma hemorrhage and the presenting symptoms of this entity, which include headache, nausea, vomiting, sudden cranial nerve dysfunction, and ataxia. A very unusual case is presented of a 36-year-old man, who unlike most of the patients reported in the literature, had clinically silent vestibular schwannoma hemorrhage. The authors also discuss the management issues involved in more than 1000 vestibular schwannomas treated at their institution during a 25-year period.

scholarly journals Translabyrinthine microsurgical resection of small vestibular schwannomas

2018 ◽  
Vol 129 (1) ◽  
pp. 128-136 ◽  
Author(s):  
Marc S. Schwartz ◽  
Gregory P. Lekovic ◽  
Mia E. Miller ◽  
William H. Slattery ◽  
Eric P. Wilkinson
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Sinus Thrombosis ◽  
Treatment Options ◽  
Previous Treatment ◽  
Cerebrospinal Fluid Leak ◽  
Neurofibromatosis Type ◽  
Additional Treatment ◽  
Vestibular Schwannomas ◽  
Tumor Control

OBJECTIVETranslabyrinthine 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.METHODSData 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.RESULTSPathologically, 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.CONCLUSIONSTranslabyrinthine 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.

scholarly journals Noncontrast vestibular schwannoma surveillance imaging including an MR cisternographic sequence: is there a need for postcontrast imaging?

2019 ◽  
Vol 131 (2) ◽  
pp. 549-554 ◽  
Author(s):  
Karen Buch ◽  
Amy Juliano ◽  
Konstantina M. Stankovic ◽  
Hugh D. Curtin ◽  
Mary Beth Cunnane
Keyword(s):  
Vestibular Schwannoma ◽  
Relevant Information ◽  
Vestibular Schwannomas ◽  
Mr Images ◽  
Gadolinium Contrast ◽  
Additional Information ◽  
Significant Difference ◽  
T1 Hyperintensity ◽  
Temporal Bones ◽  
Mr Sequences

OBJECTIVEThe purpose of this study was to evaluate the use of a noncontrast MRI protocol that includes a cisternographic sequence (CISS/FIESTA/3D DRIVE) compared to a protocol that includes a gadolinium-enhanced sequence in order to determine whether a noncontrast approach could be utilized to follow vestibular schwannomas.METHODSA total of 251 patients with vestibular schwannomas who underwent MRI of the temporal bones that included both cisternographic sequence and postcontrast T1 imaging between January 2000 and January 2016 for surveillance were included in this retrospective study. The size of the vestibular schwannomas was independently assessed on a noncontrast MR cisternographic sequence and compared to size measurements on a postcontrast sequence. The evaluation of intralesional cystic components (identified as T2 signal hyperintensity) and hemorrhagic components (identified with intrinsic T1 hyperintensity) on noncontrast MR sequences was compared to evaluation on postcontrast MR sequences to determine whether additional information could be derived from the postcontrast sequences. Additionally, any potentially clinically significant, incidentally detected findings on the postcontrast T1 sequences were documented and compared with the detection of these findings on the precontrast images.RESULTSNo significant difference in vestibular schwannoma size was found when comparing measurements made on the images obtained with the MR cisternographic sequence and those made on images obtained with the postcontrast sequence (p = 0.99). Noncontrast MR images were better (detection rate of 87%) than postcontrast images for detection of cystic components. Noncontrast MR images were also better for identifying hemorrhagic components. No additional clinically relevant information regarding the tumors was identified on the postcontrast sequences.CONCLUSIONSBased on the results of this study, a noncontrast MR protocol that includes a cisternographic sequence would be sufficient for the accurate characterization of size and signal characteristics of vestibular schwannomas, obviating the need for gadolinium contrast administration for the routine surveillance of these lesions.

Sign in / Sign up

Export Citation Format

Share Document