Microsurgery for Recurrent Vestibular Schwannoma After Previous Gross Total Resection

2017 ◽  
Vol 38 (6) ◽  
pp. 882-888 ◽  
Author(s):  
Avital Perry ◽  
Christopher S. Graffeo ◽  
William R. Copeland ◽  
Matthew L. Carlson ◽  
Brian A. Neff ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Total Resection

scholarly journals Microsurgical Gross Total Resection of a Large Residual/Recurrent Vestibular Schwannoma via Translabyrinthine Approach

2018 ◽  
Vol 79 (S 05) ◽  
pp. S387-S388
Author(s):  
Sima Sayyahmelli ◽  
Joseph Roche ◽  
Mustafa Baskaya
Keyword(s):  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Entry Zone ◽  
Stereotactic Radiation ◽  
Translabyrinthine Approach ◽  
History Of ◽  
Microsurgical Techniques ◽  
Facial Function

Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a translabyrinthine approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed.The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw.

scholarly journals Translabyrinthine Approach for Resection of Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S286-S286 ◽  
Author(s):  
Yening Feng ◽  
Neil S. Patel ◽  
Jamie J. Van Gompel ◽  
Matthew L. Carlson
Keyword(s):  
Vestibular Schwannoma ◽  
Severe Headache ◽  
Gross Total Resection ◽  
Instructional Video ◽  
Facial Nerve Function ◽  
Surgical Indications ◽  
Total Resection ◽  
Frequent Episodes ◽  
Patient Reported ◽  
Video Documents

Objectives This video describes the surgical indications, relevant anatomy, and surgical steps of routine translabyrinthine surgery for gross total resection of sporadic vestibular schwannoma. Design The procedure is presented through a surgical instructional video. Setting The surgery took place at tertiary skull base referral center. Parcipant A 47-year-old patient reported with nonserviceable hearing, frequent episodes of vertigo, recurrent severe headache, and a small unilateral right sided vestibular schwannoma. Results Gross total resection with preservation of facial nerve function was achieved. Conclusion This instructional video documents the surgical steps and relevant anatomy for translabyrinthine resection of vestibular schwannoma.The link to the video can be found at: https://youtu.be/CJ2vKMLs7aI.

scholarly journals Retrosigmoid Approach for Resection of Medium-Sized Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S284-S284
Author(s):  
Michael J. Link ◽  
Colin L. W. Driscoll ◽  
Yening Feng ◽  
Maria Peris-Celda ◽  
Christopher S. Graffeo
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Instructional Video ◽  
Hearing Level ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Pure Tone Average ◽  
Petrous Temporal Bone

Objectives This video was aimed to describe the relevant anatomy and key surgical steps of retrosigmoid approach for gross total resection of a medium-sized vestibular schwannoma (VS). Design The procedure is described in a surgical instructional video. Setting The surgery took place at a tertiary skull base referral center. Participant Patient is a 63-year-old woman who reported with nonserviceable hearing (Pure Tone Average 60 dB Hearing level, Word Recognition Score 45%), occasional tinnitus, and a VS in the left cerebellopontine angle (CPA), extending into internal auditory canal (IAC), measuring 1.7 cm parallel to the petrous temporal bone. Main Outcome Measures The VS was resected by retrosigmoid approach. Results The surgery results gross total resection of the VS with postoperative House–Brackmann grade 1 facial nerve function and no postoperative complications. Conclusion The retrosigmoid approach is a good strategy to remove VS involving the CPA and the IAC.The link to the video can be found at: https://youtu.be/B6K_UkrKitg.

Microsurgical Outcomes After Gross Total Resection on Vestibular Schwannoma in Elderly Patients: A Matched Cohort Study

2017 ◽  
Vol 101 ◽  
pp. 457-465 ◽  
Author(s):  
Nian Jiang ◽  
Zaibin Wang ◽  
Wen Chen ◽  
Yuanyang Xie ◽  
Zefeng Peng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Matched Cohort ◽  
Total Resection ◽  
Matched Cohort Study

Vestibular schwannoma management

1998 ◽  
Vol 89 (6) ◽  
pp. 949-955 ◽  
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.

scholarly journals Cerebrospinal Fluid Leak Rate after Vestibular Schwannoma Surgery via Middle Cranial Fossa Approach

2018 ◽  
Vol 80 (04) ◽  
pp. 437-440 ◽  
Author(s):  
Noga Lipschitz ◽  
Gavriel D. Kohlberg ◽  
Kareem O. Tawfik ◽  
Zoe A. Walters ◽  
Joseph T. Breen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Leak Rate ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Tumor Diameter ◽  
Total Resection ◽  
Csf Leakage ◽  
Cranial Fossa

Objective Evaluate the cerebrospinal fluid (CSF) leak rate after the middle cranial fossa (MCF) approach to vestibular schwannoma (VS) resection. Design Retrospective case series. Setting Quaternary referral academic center. Participants Of 161 patients undergoing the MCF approach for a variety of skull base pathologies, 66 patients underwent this approach for VS resection between 2007 and 2017. Main Outcome Measure Postoperative CSF leak rate. Results There were two instances of postoperative CSF leak (3.0%). Age, gender, and BMI were not significantly associated with CSF leak. In the two cases with CSF leakage, tumors were isolated to the internal auditory canal (IAC) and both underwent gross total resection. Both CSF leaks were successfully treated with lumbar drain diversion. For the 64 cases that did not have a CSF leak, 51 were isolated to the IAC, 1 was located only in the cerebellopontine angle (CPA), and 12 were located in both the IAC and CPA. 62 patients underwent gross total resection and 2 underwent near-total resection. Mean maximal tumor diameter in the CSF leak group was 4.5 mm (range: 3–6 mm) versus 10.2 mm (range: 3–19 mm) in patients with no CSF leak (p = 0.03). Conclusions The MCF approach for VS resection is a valuable technique that allows for hearing preservation and total tumor resection and can be performed with a low CSF leakage rate. This rate of CSF leak is less than the reported rates in the literature in regard to both translabyrinthine and retrosigmoid approaches.

scholarly journals Microsurgery for Recurrent Vestibular Schwannoma after Previous Gross Total Resection

2017 ◽  
Vol 78 (S 01) ◽  
pp. S1-S156
Author(s):  
Avital Perry ◽  
Christopher Graffeo ◽  
William III ◽  
Matthew Carlson ◽  
Brian Neff ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Total Resection

scholarly journals Retrosigmoid Craniectomy for Vestibular Schwannoma with Hearing Preservation

2018 ◽  
Vol 80 (S 03) ◽  
pp. S274-S275
Author(s):  
Anthony M. Tolisano ◽  
Ankur R. Patel ◽  
Samuel L. Barnett ◽  
Brandon Isaacson
Keyword(s):  
Skull Base ◽  
Vestibular Schwannoma ◽  
Skull Base Surgery ◽  
Tertiary Care ◽  
Hearing Preservation ◽  
Normal Hearing ◽  
Surgical Anatomy ◽  
Gross Total Resection ◽  
Single Patient ◽  
Total Resection

Objectives To describe a retrosigmoid craniectomy, hearing-preservation approach for resection of vestibular schwannoma. Design/Setting/Participants A video of a single patient undergoing the above approach at a tertiary care skull base surgery program. Results This video demonstrates a retrosigmoid craniectomy approach for resection of an enlarging intracanalicular vestibular schwannoma in a patient with normal hearing. The video highlights the pertinent surgical anatomy and outlines in a step-by-step fashion the surgical steps. The patient obtained a gross total resection with preservation of hearing. Conclusion A retrosigmoid craniectomy approach for vestibular schwannoma offers a potentially hearing preservation approach for selected tumors.The link to the video can be found at: https://youtu.be/VM663XztRZw.

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