Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery: a technical feasibility study
Background Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulati...
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| Veröffentlicht in: | Acta neurochirurgica 2021-08, Vol.163 (8), p.2219-2224 |
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| container_title | Acta neurochirurgica |
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| creator | Labib, Mohamed A. Inoue, Mizuho Banakis Hartl, Renee M. Cass, Stephen Gubbels, Samuel Lawton, Michael T. Youssef, A. Samy |
| description | Background
Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulation and preserve the function of the facial and cochlear nerves.
Methods
The vestibular nerve preservation technique was prospectively applied to resect small VS tumors in patients with serviceable preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B). Clinical and radiological data were recorded and analyzed.
Results
Ten patients met the inclusion criteria. The mean (SD) age was 40.4 (12.5) years. Follow-up ranged from 6 weeks to 2 years. The maximum tumor diameter parallel to the internal auditory canal ranged from 10 to 20 mm (mean, 14.9 (3.1) mm). There were three Koos grade 3 and seven Koos grade 2 tumors. Gross total resection was achieved in all cases. Both the facial and cochlear nerves were anatomically preserved in all cases. Postoperatively, 7 patients (70%) remained in the AAO-HNS class A or B hearing category. None of the patients had new vestibular symptoms, and all had House–Brackmann grade 1 facial function. Nervus intermedius dysfunction was observed in 1 patient preoperatively, which worsened postoperatively. Two patients had new nervus intermedius symptoms postoperatively.
Conclusion
Improvement of facial nerve and hearing outcomes is feasible through the intentional preservation of the vestibular nerves in the resection of small VSs. Longer follow-up is required to rule out tumor recurrence. |
| doi_str_mv | 10.1007/s00701-020-04678-y |
| format | Article |
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Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulation and preserve the function of the facial and cochlear nerves.
Methods
The vestibular nerve preservation technique was prospectively applied to resect small VS tumors in patients with serviceable preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B). Clinical and radiological data were recorded and analyzed.
Results
Ten patients met the inclusion criteria. The mean (SD) age was 40.4 (12.5) years. Follow-up ranged from 6 weeks to 2 years. The maximum tumor diameter parallel to the internal auditory canal ranged from 10 to 20 mm (mean, 14.9 (3.1) mm). There were three Koos grade 3 and seven Koos grade 2 tumors. Gross total resection was achieved in all cases. Both the facial and cochlear nerves were anatomically preserved in all cases. Postoperatively, 7 patients (70%) remained in the AAO-HNS class A or B hearing category. None of the patients had new vestibular symptoms, and all had House–Brackmann grade 1 facial function. Nervus intermedius dysfunction was observed in 1 patient preoperatively, which worsened postoperatively. Two patients had new nervus intermedius symptoms postoperatively.
Conclusion
Improvement of facial nerve and hearing outcomes is feasible through the intentional preservation of the vestibular nerves in the resection of small VSs. Longer follow-up is required to rule out tumor recurrence.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-020-04678-y</identifier><identifier>PMID: 33389124</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Cochlea ; Ear canal ; Facial nerve ; Feasibility studies ; Head and neck ; Hearing ; Interventional Radiology ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Nerves ; Neurology ; Neuroradiology ; Neurosurgery ; Original Article - Tumor - Schwannoma ; Patients ; Preservation ; Schwann cells ; Surgery ; Surgical Orthopedics ; Tumor – Schwannoma ; Tumors ; Vestibular nerve ; Vestibular system</subject><ispartof>Acta neurochirurgica, 2021-08, Vol.163 (8), p.2219-2224</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH, AT part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH, AT part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-2ea4ddaa2dcb9567bfaef985dc185ba137adba03947de388008da39daed1e3123</citedby><cites>FETCH-LOGICAL-c375t-2ea4ddaa2dcb9567bfaef985dc185ba137adba03947de388008da39daed1e3123</cites><orcidid>0000-0001-6269-6857</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-020-04678-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-020-04678-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33389124$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Labib, Mohamed A.</creatorcontrib><creatorcontrib>Inoue, Mizuho</creatorcontrib><creatorcontrib>Banakis Hartl, Renee M.</creatorcontrib><creatorcontrib>Cass, Stephen</creatorcontrib><creatorcontrib>Gubbels, Samuel</creatorcontrib><creatorcontrib>Lawton, Michael T.</creatorcontrib><creatorcontrib>Youssef, A. Samy</creatorcontrib><title>Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery: a technical feasibility study</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Background
Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulation and preserve the function of the facial and cochlear nerves.
Methods
The vestibular nerve preservation technique was prospectively applied to resect small VS tumors in patients with serviceable preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B). Clinical and radiological data were recorded and analyzed.
Results
Ten patients met the inclusion criteria. The mean (SD) age was 40.4 (12.5) years. Follow-up ranged from 6 weeks to 2 years. The maximum tumor diameter parallel to the internal auditory canal ranged from 10 to 20 mm (mean, 14.9 (3.1) mm). There were three Koos grade 3 and seven Koos grade 2 tumors. Gross total resection was achieved in all cases. Both the facial and cochlear nerves were anatomically preserved in all cases. Postoperatively, 7 patients (70%) remained in the AAO-HNS class A or B hearing category. None of the patients had new vestibular symptoms, and all had House–Brackmann grade 1 facial function. Nervus intermedius dysfunction was observed in 1 patient preoperatively, which worsened postoperatively. Two patients had new nervus intermedius symptoms postoperatively.
Conclusion
Improvement of facial nerve and hearing outcomes is feasible through the intentional preservation of the vestibular nerves in the resection of small VSs. Longer follow-up is required to rule out tumor recurrence.</description><subject>Cochlea</subject><subject>Ear canal</subject><subject>Facial nerve</subject><subject>Feasibility studies</subject><subject>Head and neck</subject><subject>Hearing</subject><subject>Interventional Radiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Nerves</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original Article - Tumor - Schwannoma</subject><subject>Patients</subject><subject>Preservation</subject><subject>Schwann cells</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Tumor – Schwannoma</subject><subject>Tumors</subject><subject>Vestibular nerve</subject><subject>Vestibular system</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhi0Eohd4ARbIEhs2Ad9y4nRXVbRUqsQG1tbEnvS4SuzUTlrlHXjo-vQUWrFAssZjzT-_R_MR8oGzL5yx5msugfGKCVYxtWl0tb4ih6xVoiqBvS45K-WN2OgDcpTzTXmJRsm35EBKqVsu1CH5fTlOYGcae3qHefbdMkCiAdMd0ilhLgnMPgZaTg_Ww0AhOLpFSD5c07jMNo6YqQ80jzAML12y3d5DCHEEmpd0jWk9oUBntNvgbTHqEbLv_ODnleZ5ces78qaHIeP7p_uY_Dr_9vPse3X14-Ly7PSqsrKp50ogKOcAhLNdW2-argfsW107y3XdAZcNuA6YbFXjUGrNmHYgWwfoOEou5DH5vPedUrxdysBm9NniMEDAuGQjVFOzVnLOivTTP9KbuKRQpjOiVq1WhcHOUOxVNsWcE_ZmSn6EtBrOzI6V2bMyhZV5ZGXW0vTxyXrpRnR_W_7AKQK5F-Rpt2xMz3__x_YB0U-jig</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Labib, Mohamed A.</creator><creator>Inoue, Mizuho</creator><creator>Banakis Hartl, Renee M.</creator><creator>Cass, Stephen</creator><creator>Gubbels, Samuel</creator><creator>Lawton, Michael T.</creator><creator>Youssef, A. Samy</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6269-6857</orcidid></search><sort><creationdate>20210801</creationdate><title>Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery: a technical feasibility study</title><author>Labib, Mohamed A. ; Inoue, Mizuho ; Banakis Hartl, Renee M. ; Cass, Stephen ; Gubbels, Samuel ; Lawton, Michael T. ; Youssef, A. Samy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-2ea4ddaa2dcb9567bfaef985dc185ba137adba03947de388008da39daed1e3123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cochlea</topic><topic>Ear canal</topic><topic>Facial nerve</topic><topic>Feasibility studies</topic><topic>Head and neck</topic><topic>Hearing</topic><topic>Interventional Radiology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgery</topic><topic>Nerves</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original Article - Tumor - Schwannoma</topic><topic>Patients</topic><topic>Preservation</topic><topic>Schwann cells</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Tumor – Schwannoma</topic><topic>Tumors</topic><topic>Vestibular nerve</topic><topic>Vestibular system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Labib, Mohamed A.</creatorcontrib><creatorcontrib>Inoue, Mizuho</creatorcontrib><creatorcontrib>Banakis Hartl, Renee M.</creatorcontrib><creatorcontrib>Cass, Stephen</creatorcontrib><creatorcontrib>Gubbels, Samuel</creatorcontrib><creatorcontrib>Lawton, Michael T.</creatorcontrib><creatorcontrib>Youssef, A. Samy</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Labib, Mohamed A.</au><au>Inoue, Mizuho</au><au>Banakis Hartl, Renee M.</au><au>Cass, Stephen</au><au>Gubbels, Samuel</au><au>Lawton, Michael T.</au><au>Youssef, A. Samy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery: a technical feasibility study</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>163</volume><issue>8</issue><spage>2219</spage><epage>2224</epage><pages>2219-2224</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Background
Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulation and preserve the function of the facial and cochlear nerves.
Methods
The vestibular nerve preservation technique was prospectively applied to resect small VS tumors in patients with serviceable preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B). Clinical and radiological data were recorded and analyzed.
Results
Ten patients met the inclusion criteria. The mean (SD) age was 40.4 (12.5) years. Follow-up ranged from 6 weeks to 2 years. The maximum tumor diameter parallel to the internal auditory canal ranged from 10 to 20 mm (mean, 14.9 (3.1) mm). There were three Koos grade 3 and seven Koos grade 2 tumors. Gross total resection was achieved in all cases. Both the facial and cochlear nerves were anatomically preserved in all cases. Postoperatively, 7 patients (70%) remained in the AAO-HNS class A or B hearing category. None of the patients had new vestibular symptoms, and all had House–Brackmann grade 1 facial function. Nervus intermedius dysfunction was observed in 1 patient preoperatively, which worsened postoperatively. Two patients had new nervus intermedius symptoms postoperatively.
Conclusion
Improvement of facial nerve and hearing outcomes is feasible through the intentional preservation of the vestibular nerves in the resection of small VSs. Longer follow-up is required to rule out tumor recurrence.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>33389124</pmid><doi>10.1007/s00701-020-04678-y</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-6269-6857</orcidid></addata></record> |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Cochlea Ear canal Facial nerve Feasibility studies Head and neck Hearing Interventional Radiology Medicine Medicine & Public Health Minimally Invasive Surgery Nerves Neurology Neuroradiology Neurosurgery Original Article - Tumor - Schwannoma Patients Preservation Schwann cells Surgery Surgical Orthopedics Tumor – Schwannoma Tumors Vestibular nerve Vestibular system |
| title | Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery: a technical feasibility study |
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