Establishing Interdisciplinary Surgery of Vestibular Schwannomas: Summary of a Single-Center Experience in 145 Cases

Objective: To evaluate the interdisciplinary concept (neurosurgery/ear, nose, and throat [ENT]) of treating vestibular schwannomas with extrameatal extension via the retromastoidal suboccipital approach.

Design: Retrospective analysis in a single center.

Patients/Materials and Methods: The team approach in Fulda was introduced by the senior author. Over a period of 10 years, 145 patients underwent interdisciplinary surgery via a retrosigmoid approach in a semisitting position.

The mean axial mediolateral tumor extension measured 16.9 mm, ranging from 0.9 to 51 mm. Facial monitoring and continuous BAEP recording were performed routinely. Functional outcome of the facial nerve was evaluated according to the House-Brackmann scale, and hearing preservation was classified using the Gardner/Robertson system.

Results: Gross-total resection was achieved and documented by MR imaging 1 year after surgery in 91.1%. In the other 8.9%, capsule remnants had to be left. The rate of excellent/good facial nerve function (House-Brackmann I-II) was 96%. Good functional hearing (Gardner/Robertson 1–3) was preserved in 39.8%. Working together in extra- intrameatal VS was highly appreciated by all colleagues. Patients and admitting colleagues noticed that the team approach generally improved operative treatment, and as a consequence, the number of patients increased.

Conclusions: The interdisciplinary concept of surgery of extra-intrameatal VS performed by ENTs and neurosurgeons, once established, is beneficial for all participants (patients and surgeons) because each part of the surgery is performed by a specialist who is best acquainted with the pathoanatomical region.