Vestibular Schwannoma Resection in a Consecutive Series of 502 Cases via the Retrosigmoid Approach: Technical Aspects, Complications, and Functional Outcome

Outcome in vestibular schwannoma (VS) surgery has improved enormously over the last decades. Surgical positioning remains a matter of discussion. A standardized protocol for diagnostics and management has been applied and evaluated for complications and functional outcome. We examined 502 VS tumors...

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Veröffentlicht in:World neurosurgery 2019-09, Vol.129, p.e114-e127
Hauptverfasser: Breun, Maria, Nickl, Robert, Perez, Jose, Hagen, Rudolf, Löhr, Mario, Vince, Giles, Trautner, Herbert, Ernestus, Ralf-Ingo, Matthies, Cordula
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container_end_page e127
container_issue
container_start_page e114
container_title World neurosurgery
container_volume 129
creator Breun, Maria
Nickl, Robert
Perez, Jose
Hagen, Rudolf
Löhr, Mario
Vince, Giles
Trautner, Herbert
Ernestus, Ralf-Ingo
Matthies, Cordula
description Outcome in vestibular schwannoma (VS) surgery has improved enormously over the last decades. Surgical positioning remains a matter of discussion. A standardized protocol for diagnostics and management has been applied and evaluated for complications and functional outcome. We examined 502 VS tumors in 483 patients (227 men and 256 women) between 2005 and 2016. According to our patient selection and treatment algorithm, 488 operations (97%) were performed in the semi-sitting position, and 14 (3%) were in the supine position. Auditory and facial functions were analyzed before and after surgery as were perioperative complications. There were 182 patients (36%) with small tumors (Hannover classification T1–T3A) and 320 (64%) large tumors (T3B or T4). Of the patients, 14% were neurofibromatosis type 2 cases. Complete tumor resection was achieved in 96.4%. Hearing preservation occurred in 44% of patients with small tumors and 23% of those with large tumors (Hannover classification), and correlated significantly with tumor size (P < 0.001). Facial palsy (House Brackmann grades II–VI) was present in 63 patients before and in 185 patients after surgery. Useful facial function (House Brackmann grades I–III) early after surgery was maintained in 86% of patients with small tumors and in 77% of patients with large tumors. Intraoperative complications included air embolism in 45 cases (9%), sinus injury in 3 cases, cerebrospinal fluid leakage in 46 cases (9%), and local hemorrhage in 19 cases (4%). Surgical revision was indicated in 31 cases (6%). In a standardized setting, the semi-sitting position allowed a safe approach. This setting offers the advantage of bimanual tumor nerve handling by the surgeon and an optimal visualization of important functional structures.
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Surgical positioning remains a matter of discussion. A standardized protocol for diagnostics and management has been applied and evaluated for complications and functional outcome. We examined 502 VS tumors in 483 patients (227 men and 256 women) between 2005 and 2016. According to our patient selection and treatment algorithm, 488 operations (97%) were performed in the semi-sitting position, and 14 (3%) were in the supine position. Auditory and facial functions were analyzed before and after surgery as were perioperative complications. There were 182 patients (36%) with small tumors (Hannover classification T1–T3A) and 320 (64%) large tumors (T3B or T4). Of the patients, 14% were neurofibromatosis type 2 cases. Complete tumor resection was achieved in 96.4%. Hearing preservation occurred in 44% of patients with small tumors and 23% of those with large tumors (Hannover classification), and correlated significantly with tumor size (P &lt; 0.001). Facial palsy (House Brackmann grades II–VI) was present in 63 patients before and in 185 patients after surgery. Useful facial function (House Brackmann grades I–III) early after surgery was maintained in 86% of patients with small tumors and in 77% of patients with large tumors. Intraoperative complications included air embolism in 45 cases (9%), sinus injury in 3 cases, cerebrospinal fluid leakage in 46 cases (9%), and local hemorrhage in 19 cases (4%). Surgical revision was indicated in 31 cases (6%). In a standardized setting, the semi-sitting position allowed a safe approach. 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subjects Acoustic neuromas/acoustic neurinomas/vestibular schwannomas
Adult
Aged
Complications
Female
Functional outcome
Humans
Male
Middle Aged
Morbidity
Neuroma, Acoustic - surgery
Neurosurgical Procedures - methods
Patient Positioning
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Recovery of Function
Retrosigmoid approach
Retrospective Studies
Semi-sitting position
Surgery
Technique
title Vestibular Schwannoma Resection in a Consecutive Series of 502 Cases via the Retrosigmoid Approach: Technical Aspects, Complications, and Functional Outcome
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