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Acta Neurochirurgica

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18.09.2018 | Original Article - Tumor - Schwannoma

Surgical outcome in smaller symptomatic vestibular schwannomas. Is there a role for surgery?

verfasst von: Amrit K. Chiluwal, Alyssa Rothman, Maja Svrakic, Amir R. Dehdashti

Erschienen in: Acta Neurochirurgica | Ausgabe 11/2018

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Abstract

Background

Currently, there is no consensus in the initial management of small vestibular schwannomas (VSs). They are routinely watched and/or referred for radiosurgical treatment, although surgical removal is also an option. We hereby evaluate clinical outcomes of patients who have undergone surgical removal of smaller symptomatic VSs.

Methods

Patients with vestibular schwannomas (grade T1–T3b according to Hannover classification) were reviewed. Patients with symptomatic tumors who underwent surgery were evaluated. Their preoperative hearing status was based on the guideline of the committee on hearing and equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) foundation. Their postoperative facial nerve function, hearing status, vestibular symptoms, and degree of tumor resection were assessed.

Results

Thirty patients were selected for surgery via a retrosigmoid approach based on their age, symptoms, and their own decision-making after discussion of management options. Most patients presented with hearing loss. Seventeen patients had useful hearing preoperatively. Among them, 10 patients (59%) preserved useful hearing (class A or B) postoperatively. MRI at 1-year follow-up confirmed complete resection in 26/29 patients. Also, 29 patients (97%) had HB grade I–II, and 1 patient had HB III at 1-year follow-up. Except for 1 patient with CSF leak, 1 patient with delayed facial nerve palsy, and 2 patients with asymptomatic sigmoid sinus occlusion, there were no other new morbidities.

Conclusion

Although both observation and radiosurgery are valid options in the management of smaller size vestibular schwannomas, surgical treatment seems to offer a high rate of facial nerve preservation, a reasonable rate of hearing sparing, and a high total resection rate. Clinicians should consider surgical treatment as a valid option in the initial management of symptomatic small vestibular schwannomas in younger patients.

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Titel: Surgical outcome in smaller symptomatic vestibular schwannomas. Is there a role for surgery?
verfasst von: Amrit K. Chiluwal
Alyssa Rothman
Maja Svrakic
Amir R. Dehdashti
Publikationsdatum: 18.09.2018
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 11/2018
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-018-3674-x

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Surgical outcome in smaller symptomatic vestibular schwannomas. Is there a role for surgery?

Abstract

Background

Methods

Results

Conclusion

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Abstract

Background

Methods

Results

Conclusion

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