Management of 1000 Vestibular Schwannomas (Acoustic Neuromas): The Facial Nerve-Preservation and Restitution of Function

Neurosurgery ◽  
1997 ◽  
Vol 40 (4) ◽  
pp. 684-695 ◽  
Author(s):  
Madjid Samii ◽  
Cordula Matthies
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Acoustic Neuromas

scholarly journals Keyhole retrosigmoid approach for large vestibular schwannomas: strategies to improve outcomes

2018 ◽  
Vol 44 (3) ◽  
pp. E2 ◽  
Author(s):  
Reid Hoshide ◽  
Harrison Faulkner ◽  
Mario Teo ◽  
Charles Teo
Keyword(s):  
Minimally Invasive ◽  
Facial Nerve ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Retrosigmoid Approach ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

OBJECTIVEThere are numerous treatment strategies in the management for large vestibular schwannomas, including resection only, staged resections, resections followed by radiosurgery, and radiosurgery only. Recent evidence has pointed toward maximal resection as being the optimum strategy to prevent tumor recurrence; however, durable tumor control through aggressive resection has been shown to occur at the expense of facial nerve function and to risk other approach-related complications. Through a retrospective analysis of their single-institution series of keyhole neurosurgical approaches for large vestibular schwannomas, the authors aim to report and justify key techniques to maximize tumor resection and reduce surgical morbidity.METHODSA retrospective chart review was performed at the Centre for Minimally Invasive Neurosurgery. All patients who had undergone a keyhole retrosigmoid approach for the resection of large vestibular schwannomas, defined as having a tumor diameter of ≥ 3.0 cm, were included in this review. Patient demographics, preoperative cranial nerve status, perioperative data, and postoperative follow-up were obtained. A review of the literature for resections of large vestibular schwannomas was also performed. The authors’ institutional data were compared with the historical data from the literature.RESULTSBetween 2004 and 2017, 45 patients met the inclusion criteria for this retrospective chart review. When compared with findings in a historical cohort in the literature, the authors’ minimally invasive, keyhole retrosigmoid technique for the resection of large vestibular schwannomas achieved higher rates of gross-total or near-total resection (100% vs 83%). Moreover, these results compare favorably with the literature in facial nerve preservation (House-Brackmann I–II) at follow-up after gross-total resections (81% vs 47%, p < 0.001) and near-total resections (88% vs 75%, p = 0.028). There were no approach-related complications in this series.CONCLUSIONSIt is the experience of the senior author that complete or near-complete resection of large vestibular schwannomas can be successfully achieved via a keyhole approach. In this series of 45 large vestibular schwannomas, a greater extent of resection was achieved while demonstrating high rates of facial nerve preservation and low approach-related and postoperative complications compared with the literature.

scholarly journals Retractorless translabyrinthine approach for resection of a large acoustic neuroma: operative video and technical nuances

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu ◽  
Robert W. Jyung
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Tumor Resection ◽  
Fat Graft ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Large acoustic neuromas, greater than 3 cm, can be technically challenging tumors to remove because of their intimate relationship with the brainstem and surrounding cranial nerves. Successful tumor resection involves functional preservation of the facial nerve and neurovascular structures. The translabyrinthine approach is useful for surgical resection of acoustic neuromas of various sizes in patients with poor preoperative hearing. The presigmoid surgical corridor allows direct exposure of the tumor in the cerebellopontine angle without any fixed cerebellar retraction. Early identification of the facial nerve at the fundus facilitates facial nerve preservation. Large acoustic tumors can be readily removed with a retractorless translabyrinthine approach using dynamic mobilization of the sigmoid sinus. In this operative video atlas report, the authors demonstrate their operative nuances for resection of a large acoustic neuroma via a translabyrinthine approach using a retractorless technique. Facial nerve preservation is achieved by maintaining a plane of dissection between the tumor capsule and the tumor arachnoid so that a layer of arachnoid protects the blood supply to the facial nerve. Multilayered closure is achieved with a fascial sling technique in which an autologous fascia lata graft is sutured to the dural defect to suspend the fat graft in the mastoidectomy defect. We describe the step-by-step technique and illustrate the operative nuances and surgical pearls to safely and efficiently perform the retractorless translabyrinthine approach, tumor resection, facial nerve preservation, and multi-layered reconstruction of the skull base dural defect to prevent postoperative cerebrospinal fluid leakage.The video can be found here: http://youtu.be/ros98UxqVMw.

Radiosurgery treatment is associated with improved facial nerve preservation versus repeat resection in recurrent vestibular schwannomas

2019 ◽  
Vol 161 (7) ◽  
pp. 1449-1456 ◽  
Author(s):  
Prasanth Romiyo ◽  
Edwin Ng ◽  
Dillon Dejam ◽  
Kevin Ding ◽  
John P Sheppard ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Repeat Resection ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

Facial Nerve Preservation in Surgery of T3 and T4 Vestibular Schwannomas

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
C. Matthies ◽  
J. Perez ◽  
F. Raslan ◽  
G. Vince ◽  
T. Westermaier ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

Facial Nerve Preservation Surgery for Koos Stage 3 and 4 Vestibular Schwannomas

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
Amjad Anaizi ◽  
Eric Gantwerker ◽  
Myles Pensak ◽  
Philip Theodosopoulos
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

Optimizing Facial Nerve Preservation in Surgery of Vestibular Schwannomas

2014 ◽  
Vol 75 (S 02) ◽  
Author(s):  
Cordula Matthies ◽  
M. Hummel ◽  
J. Perez ◽  
R. Hagen ◽  
R. Ernestus
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

Vestibular Schwannomas: An Analysis of Surgically Treated 259 Cases with Special Reference of Facial Nerve Preservation

Skull Base ◽  
2009 ◽  
Vol 19 (03) ◽  
Author(s):  
Awadhesh Jaiswal ◽  
Sushila Jaiswal ◽  
Arun Srivastava ◽  
Rabi Sahu ◽  
Sanjay Behari ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Special Reference ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Facial Nerve Preservation

Resection of vestibular schwannomas after stereotactic radiosurgery: a systematic review

2020 ◽  
pp. 1-9
Author(s):  
Max Whitmeyer ◽  
Bledi C. Brahimaj ◽  
André Beer-Furlan ◽  
Sameer Alvi ◽  
Madeline J. Epsten ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Surgical Approach ◽  
Salvage Surgery ◽  
Vestibular Schwannomas ◽  
Cochrane Library ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Primary Indication

OBJECTIVEMultiple short series have evaluated the efficacy of salvage microsurgery (MS) after stereotactic radiosurgery (SRS) for treatment of vestibular schwannomas (VSs); however, there is a lack of a large volume of patient data available for interpretation and clinical adaptation. The goal of this study was to provide a comprehensive review of tumor characteristics, management, and surgical outcomes of salvage of MS after SRS for VS.METHODSThe Medline/PubMed, Scopus, CINAHL, Cochrane Library, and Google Scholar databases were queried according to PRISMA guidelines. All English-language and translated publications were included. Studies lacking adequate study characteristics and outcomes were excluded. Cases involving neurofibromatosis type 2, previous MS, or malignant transformation were excluded when possible.RESULTSTwenty studies containing 297 cases met inclusion criteria. Three additional cases from Rush University Medical Center were added for 300 total cases. Tumor growth with or without symptoms was the primary indication for salvage surgery (92.3% of cases), followed by worsening of symptoms without growth (4.6%) and cystic enlargement (3.1%). The average time to MS after SRS was 39.4 months. The average size and volume of tumor at surgery were 2.44 cm and 5.92 cm3, respectively. The surgical approach was retrosigmoid (42.8%) and translabyrinthine (57.2%); 59.5% of patients had a House-Brackmann (HB) grade of I or II. The facial nerve was preserved in 91.5% of cases. Facial nerve preservation and HB grades were lower for the translabyrinthine versus retrosigmoid approach (p = 0.31 and p = 0.18, respectively); however, fewer complications were noted in the translabyrinthine approach (p = 0.29). Gross-total resection (GTR) was completed in 55.7% of surgeries. Studies that predominantly used subtotal resection (STR) were associated with a lower rate of facial nerve injury (5.3% vs 11.3%, p = 0.07) and higher rate of HB grade I or II (72.9% vs 48.0%, p = 0.00003) versus those using predominantly GTR. However, majority STR was associated with a recurrence rate of 3.6% as compared to 1.4% for majority GTR (p = 0.29).CONCLUSIONSThis study showed that the leading cause of MS after SRS was tumor growth at an average of 39.4 months after radiation. There were no significant differences in outcomes of facial nerve preservation, postoperative HB grade, or complication rate based on surgical approach. Patients who underwent STR showed statistically significant better HB outcomes compared with GTR. MS after SRS was considered by most authors to be more difficult than primary MS. These data support the notion that the surgical goals of salvage surgery are debulking of tumor mass, decreasing compression of the brainstem, and not necessarily pursuing GTR.

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