766 Endoscopic Surgery for Sporadic Vestibular Schwannoma Resection: A Systematic Review of Surgical Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Chiuta ◽  
S Raza-Knight ◽  
A Alalade
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Extent Of Resection ◽  
Current Data ◽  
Resection Rate ◽  
Eighth Cranial Nerve ◽  
Nerve Preservation ◽  
Microsurgical Resection ◽  
Hearing Outcomes ◽  
Series Report

Abstract Introduction Vestibular schwannomas (VS) are benign intracranial tumours originating from the vestibular division of the eighth cranial nerve. The mainstay of their surgical management is microsurgery, other options are radiotherapy or radiological monitoring. Endoscopy (ES) is becoming widely used in neurosurgery and may have a role in improving visualisation and outcomes by enhancing extent of resection, facial nerve, and hearing preservation in VS resection and describe the postoperative outcomes. Method The review was conducted according to the PRISMA guidelines and yielded 31 studies for inclusion. Systematic searches of literature databases were done for studies where endoscopic-assisted and/or endoscopic resection of VS were reported. Results ES facial nerve preservation rates (median 91.3%, range 39.0 - 100%) were comparable to microsurgical treatment. Hearing outcomes were more variable in ES series and were under-reported. A median gross total resection rate of 97.4% (61.0 - 100%) was achieved in the ES series. Conclusions Current data suggest that ES-assisted resection of sporadic VS is not inferior to microsurgical resection with respect to facial nerve outcomes and extent of resection. However, some ES series report poor hearing outcomes, which are under-reported in the literature.

Implications of Cystic Features in Vestibular Schwannomas of Patients Undergoing Microsurgical Resection

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 874-880 ◽  
Author(s):  
Brian J. Jian ◽  
Michael E. Sughrue ◽  
Rajwant Kaur ◽  
Martin J. Rutkowski ◽  
Ari J. Kane ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Postoperative Outcome ◽  
Hearing Preservation ◽  
Neck Surgery ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Cystic Tumors ◽  
Cystic Changes ◽  
Microsurgical Resection ◽  
Nerve Dysfunction

Abstract BACKGROUND: Cystic vestibular schwannomas (VSs) are described as being more aggressive than solid tumors. OBJECTIVE: We examined 468 VS patients to evaluate whether the presence of cystic components in VSs may be an important feature for predicting postoperative outcome. METHODS: We selected all VS patients from a prospectively collected database (1984–2009) who underwent microsurgical resection for VS. Hearing data were analyzed using American Association of Otolaryngology–Head and Neck Surgery. Facial nerve dysfunction was analyzed using the House-Brackmann scale. We used univariate comparisons to determine the clinical impact of cystic changes on preoperative and postsurgical hearing and facial nerve preservation. RESULTS: We identified 58 patients (11%) with cystic changes and 410 patients with solid VSs. In this analysis, cystic VS patients tended to have larger tumors (78% of patients with >2.0 cm extrameatal extension) compared with the solid VS group, which consisted of many smaller and medium-sized tumors (P < .0001). Univariate analyses found that tumors with cystic changes did not lead to worse rates of preoperative hearing loss (χ2, P = not significant) compared with solid VSs. Cystic changes conferred worse postoperative hearing in patients with medium-sized tumors (P = .035). Cystic changes also did not significantly affect facial nerve outcomes (χ2, P = not significant). CONCLUSION: Cystic tumors tend to be larger than noncystic tumors and affect outcomes by reducing the rate at which hearing preservation is attempted and by worsening hearing outcome in medium-sized tumors. Further, peripheral cysts cause lower rates of hearing preservation compared with centrally located cysts.

scholarly journals Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

2017 ◽  
Vol 127 (6) ◽  
pp. 1231-1241 ◽  
Author(s):  
Randy S. D'Amico ◽  
Matei A. Banu ◽  
Petros Petridis ◽  
Alexandra S. Bercow ◽  
Hani Malone ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Extent Of Resection ◽  
Nerve Sparing ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Anatomical Features ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Tumor Origin ◽  
Microsurgical Resection

OBJECTIVEAdvanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC).METHODSMedical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve–sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated.RESULTSAccording to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes.CONCLUSIONSCPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass effect or acute neurological symptoms. Maximal safe resection with preservation of neurological function can be performed for tumors 2.5 cm or larger without significant risk of facial nerve dysfunction, and, when combined with GKRS for recurrence and/or progression, provides excellent disease control. Anatomical features of the tumor origin offer critical insights for optimizing facial nerve preservation in this cohort.

scholarly journals How I Do It: The Role of Flexible Hand-held 2μ-Thulium Laser Fiber in Microsurgical Removal of Acoustic Neuromas

2017 ◽  
Vol 78 (04) ◽  
pp. 301-307 ◽  
Author(s):  
Guglielmo Cacciotti ◽  
Raffaele Roperto ◽  
Maria Tonelli ◽  
Ettore Carpineta ◽  
Luciano Mastronardi
Keyword(s):  
Facial Nerve ◽  
Tumor Resection ◽  
Hearing Preservation ◽  
Matched Pair ◽  
Nerve Preservation ◽  
Acoustic Neuromas ◽  
Laser Fiber ◽  
Laser Focusing ◽  
Preservation Rate

Aims We performed a retrospective nonrandomized study to analyze the results of microsurgery of acoustic neuromas (AN) using 2μ-thulium flexible hand-held laser fiber (Revolix jr). Methods From September 2010 to September 2015, 89 patients suffering from AN have been operated on with microsurgical technique via retrosigmoid approach. In 37 cases, tumor resection was performed with the assistance of 2μ-thulium flexible hand-held laser fiber (L-group). Eight cases operated on with the assistance of CO2 hand-held flexible laser fiber were excluded from this study. A total of 44 patients, operated on without laser assistance during the same period, were used as comparison group (C-group) (matched pair technique). Facial nerve function was assessed with the House–Brackmann (HB) scale preoperatively, and 1 week and 6 months postoperatively. Results Overall time from incision to skin suture changed in relation to size of tumor (165–575 minutes) and was not affected by the use of laser. In 7 out of 81 cases, a preoperative facial nerve palsy HB2 and in 1 case, HB4 (permanent) were observed. In the remaining 80 cases, at 6-month follow-up, facial nerve preservation rate (HB1) was 92.5%. Hearing preservation rate (AAO-HNS A/B classes) was 68.2% (26 out of 36). Adopting a 0 to 3 scale, the mean surgeon satisfaction rate of usefulness of laser fiber was 2.7. Conclusion The use of 2μ-thulium hand-held flexible laser fiber in AN microsurgery seems to be safe and subjectively facilitates tumor resection especially in “difficult” conditions (e.g., highly vascularized and hard tumors). In this limited retrospective trial, the good functional outcome following conventional microsurgery had not further improved, nor the surgical time reduced by laser. Focusing its use on “difficult” (large and vascularized) cases may lead to different results in future.

scholarly journals Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

2006 ◽  
Vol 46 (4) ◽  
pp. 176-181 ◽  
Author(s):  
Ho Jun SEOL ◽  
Choong-hyo KIM ◽  
Chul-Kee PARK ◽  
Chi Heon KIM ◽  
Dong Gyu KIM ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Extent Of Resection ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

scholarly journals The Transcrusal Approach

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 1017-1022 ◽  
Author(s):  
Michael G. Brandt ◽  
Justin Poirier ◽  
Brian Hughes ◽  
Stephen P. Lownie ◽  
Lorne S. Parnes
Keyword(s):  
Facial Nerve ◽  
Basilar Artery ◽  
Cranial Nerve ◽  
Significant Risk ◽  
Artery Aneurysm ◽  
Hearing Preservation ◽  
Petrous Apex ◽  
Nerve Preservation ◽  
Trigeminal Schwannoma ◽  
Transcrusal Approach

Abstract OBJECTIVE This study reviewed the experience and outcomes of 1 surgical team (L.S.P., S.P.L.) using the transcrusal approach. METHODS Ten-year retrospective review of 17 consecutive patients requiring transcrusal exposure of the petrous apex and upper brainstem was performed. The main outcome measures included hearing and facial nerve preservation as measured by standard audiography and postoperative assessment using the House-Brackmann scale. RESULTS Operative indications included meningioma (5 patients), epidermoid/dermoid cyst (3 patients), trigeminal schwannoma (3 patients), giant or large upper basilar artery aneurysm (3 patients), pontine cavernoma (1 patient), chondrosarcoma (1 patient), and clival melanocytoma (1 patient). Average tumor size was 3.6 cm. Complete resection was achieved in 50% of patients with petroclival tumors. Follow-up data were obtained for 14 patients at 20 ± 4 months. Serviceable hearing was preserved in 58%. Sixty-four percent of patients demonstrated House-Brackmann stage I facial nerve function. Two patients died perioperatively (brainstem infarction). Two patients became hemiparetic, with 1 improving substantially. CSF leaks developed in 3 patients. Forty-seven percent of patients demonstrated cranial nerve V deficits. Forty-one percent of patients demonstrated deficits of cranial nerve III, IV, or VI. Vertigo, vestibular disturbance, hydrocephalus, temporal lobe contusion, or hematoma did not develop in any patients. CONCLUSION The transcrusal approach provides adequate exposure for most petroclival lesions and giant aneurysms of the upper basilar artery while offering the possibility of hearing preservation. Like all approaches to large tumors and aneurysms in this region, there is a significant risk of morbidity and mortality. However, this approach is an excellent alternative to other techniques that necessitate deliberate sacrifice of ipsilateral hearing.

Type 2 neurofibromatosis: the need for supraregional care?

1993 ◽  
Vol 107 (5) ◽  
pp. 401-406 ◽  
Author(s):  
D. Gareth R. Evans ◽  
Richard Ramsden ◽  
Susan M. Huson ◽  
Rodney Harris ◽  
Richard Lye ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Definitive Treatment ◽  
Facial Nerve Function ◽  
Operative Results ◽  
Nerve Preservation ◽  
Quality Life

The results of a U.K. study of 145 cases of type 2 neurofibromatosis has shown generally very poor operative results in terms of hearing and facial nerve preservation. Only 9 out of 118 vestibular schwannoma (acoustic neuroma) operations resulted in any clinically detectable hearing preservation and only 32 left the patient with good or normal (House grade I or II) ipsilateral facial nerve function. Although operation is still the definitive treatment of vestibular schwannoma (acoustic neuroma) and may be a lifesaving procedure, it appears that the evidence in favour of early operation is only valid when carried out in highly specialized centres. The special problems of NF2 cases who may go on to develop multiple spinal and cranial tumours making them wheelchair bound and blind as well as deaf warrants a careful experienced approach. Timing of operations may be critical for the enhancement of useful years of quality life. We therefore propose the setting up of a national NF2 register, with the management of cases at a few supraregional centres.

Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients

2006 ◽  
Vol 105 (4) ◽  
pp. 527-535 ◽  
Author(s):  
Madjid Samii ◽  
Venelin Gerganov ◽  
Amir Samii
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Neurological Status ◽  
Retrosigmoid Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Permanent Morbidity

Object The aim of this study was to evaluate and present the results of current surgical treatment of vestibular schwannomas (VSs) and to report the refinements in the operative technique. Methods The authors performed a retrospective study of 200 consecutive patients who had undergone VS surgery over a 3-year period. Patient records, operative reports, follow-up data, and neuroradiological findings were analyzed. The main outcome measures were magnetic resonance imaging, neurological status, patient complaints, and surgical complications. Complete tumor removal was achieved in 98% of patients. Anatomical preservation of the facial nerve was possible in 98.5% of patients. In patients treated for tumors with extension Classes T1, T2, and T3, the rate of facial nerve preservation was 100%. By the last follow-up examination, excellent or good facial nerve function had been achieved in 81% of the cases. By at least 1 year postsurgery, no patients had total facial palsy. In the patients with preserved hearing, the rate of anatomical preservation of the cochlear nerve was 84%. The overall rate of functional hearing preservation was 51%. There was no surgery-related permanent morbidity in this series of patients. Cerebrospinal fluid leakage was diagnosed in 2% of the patients. The mortality rate was 0%. Conclusions The goal of VS treatment should be total removal in one stage and preservation of neurological function, as they determine a patient’s quality of life. This goal can be safely and successfully achieved using the retrosigmoid approach.

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

2011 ◽  
Vol 115 (5) ◽  
pp. 917-923 ◽  
Author(s):  
Raqeeb Haque ◽  
Teresa J. Wojtasiewicz ◽  
Paul R. Gigante ◽  
Mark A. Attiah ◽  
Brendan Huang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Residual Tumor ◽  
Subtotal Resection ◽  
Nerve Sparing ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Microsurgical Resection

Object The goal of this article was to show that a combination of facial nerve–sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS). Methods Records of individuals treated by a single surgeon with a facial nerve–sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.2%) of these patients required postoperative retreatment for a significant expansion of residual tumor after microsurgery. These 20 patients were re-treated with GKS. Results The rate of preservation of good facial nerve function (Grade I or II on the House-Brackmann scale) in patients treated with microsurgery for VS was 97%. Both subtotal and gross-total resection had excellent facial nerve preservation rates (97% vs 96%), although subtotal resection carried a higher risk that patients would require retreatment. In patients re-treated with GKS after microsurgery, the rate of facial nerve preservation was 95%. Conclusions In patients with tumors that cannot be managed with radiosurgery alone, a facial nerve–sparing resection followed by GKS for any significant regrowth provides excellent facial nerve preservation rates.

Predicting hearing outcomes before primary radiosurgery for vestibular schwannomas

2020 ◽  
Vol 133 (4) ◽  
pp. 1235-1241 ◽  
Author(s):  
Stephen Johnson ◽  
Hideyuki Kano ◽  
Andrew Faramand ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Hearing Preservation ◽  
High Rate ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Speech Discrimination ◽  
Nerve Preservation ◽  
Hearing Outcomes ◽  
Preservation Rate

OBJECTIVEOptimizing outcomes in the management of patients with vestibular schwannomas (VSs) requires consideration of the patient’s goals. Earlier recognition of VS by imaging has led to an evolution in management. Stereotactic radiosurgery (SRS) has emerged as a frequently used strategy designed to reduce management risks, obtain long-term tumor control, and preserve current neurological function. The authors analyzed features that impact hearing preservation rates in patients with serviceable hearing prior to SRS.METHODSThe study included 307 patients who had serviceable hearing (Gardner-Robertson hearing scale [GR] grade 1 or 2, speech discrimination score ≥ 50%, pure tone average ≤ 50 dB) at the time of SRS. The authors evaluated parameters that included age, tumor volume, hearing status, disequilibrium, tinnitus, Koos class, sex, and tumor margin dose. The Pittsburgh Hearing Prediction Score (PHPS) was evaluated as a method to predict long-term hearing outcomes in these cases.RESULTSAt a median of 7.6 years after SRS (range 1–23 years), tumor control was achieved in 95% of patients. The overall serviceable hearing preservation rate was 77.8% at 3 years, 68.8% at 5 years, and 51.8% at 10 years. The PHPS assigns a total of 5 points based on patient age (1 point if < 45 years, 2 points if 45–59 years, and 3 points if ≥ 60 years), tumor volume (0 points if < 1.2 cm3, 1 point if ≥ 1.2 cm3), and GR grade (0 points if grade 1 hearing, 1 point if grade 2 hearing) The serviceable hearing preservation rate was 92.3% at 10 years in patients whose score total was 1. In contrast, none of the patients whose PHPS was 5 maintained serviceable hearing at 10 years (p < 0.001).CONCLUSIONSSRS resulted in a high rate of long-term tumor control and cranial nerve preservation. The PHPS helped to predict long-term hearing preservation rates in patients who underwent SRS when they still had serviceable hearing. The best long-term hearing preservation rates were found in younger patients with smaller tumor volumes.

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