CLINICAL-AND-FUNCTIONAL ASSESSMENT OF THE EARLY POSTOPERATIVE OUTCOME OF SURGICAL TREATMENT OF PATIENTS WITH VESTIBULAR SCHWANNOMA

The incidence of vestibular schwannoma (VS) increased largely within the last 50 years from 1,5 cases per 100 thousand persons to 4,2 (for the last decade). The approaches to the management of VS patients vary significantly in different medical centers and different countries. The search for the consensus in selecting strategy of VS treatment based on systemic clinical-and-functional assessment of treatment outcome is topical nowadays. The aim of study - to analyze the clinical-and-functional early postoperative outcome of the surgical treatment of vestibular schwannoma depending on the stage of the disease. The findings of the examination and the outcomes of the surgical treatment of 27 VS patients were retrospectively analyzed. The patients were treated at the Department of Subtentorial Neurosurgery of the State Institution "Romodanov Institute of Neurosurgery of the NAMS of Ukraine" in 2018-2019. According to Koos classification, three groups of the patients were delineated for the analysis of the results of the study, namely, group 1 (Koos II) - 8 (29,6 %) patients; group 2 (Koos III) - 6 (22,2 %); and group 3 (Koos IV) - 13 (48,2 %). The complex clinical examination, in particular clinical-and-instrumental otoneurological examination and the evaluation of the neurological status according to the Scale for the assessment of the functional treatment outcome were performed preoperatively and early postoperatively. The data were statistically processed. In the patients with small tumors (group 1, Koos II), the socially useful hearing on the affected side was preserved preoperatively necessitating the caution for selecting the treatment strategy in these patients. When pre- and postoperative clinical symptoms were compared in group 1, the statistically significant worsening of the hearing to the socially non-useful, the unilateral subjective tinnitus, the dysfunction of the facial nerve, the decreased sense of taste/loss of taste on the anterior 2/3 of the tongue on the affected side were found. Upon the surgical treatment, the rate of the neurological deficit increased, and the severity grade of the neurological deficit increased by about 10 points. The overall preoperative score in group 3 (Koos IV) was significantly different from that in other groups. The progression of the disease to the stage of Koos IV results in the neurological deficit that is equivalent by the set of the neurological symptoms and their severity to that in early postoperative peri