The First Fifties. Can We Achieve Acceptable Results in Vestibular Schwannoma Surgery from the Beginning?

Objective: Vestibular schwannoma surgery requires a profound knowledge of anatomy and long-standing experience of surgical skull base techniques as patients nowadays request high-quality results from any surgeon. This educes a dilemma for the young neurosurgeon as she/he is at the beginning of a learning curve. The presented series provides data that excellent results can be achieved from the beginning respecting carefully planned educational steps.

Design: The first 50 vestibular schwannomas were retrospectively evaluated concerning morbidity and mortality, with an emphasis on functional cranial nerve preservation. The results were embedded in a timeline of educational steps starting with the internship in 1999.

Results: Fifty vestibular schwannomas were consecutively operated on from July 2007 to January 2010. According to the Hannover Classification, 14% were rated as T1, 18% were T2, 46% were T3, and in 21% a T4 tumor was present. The overall facial nerve preservation rate was 96%; 79% of patients with T1-3 tumors had no facial palsy at all, and 15% with House-Brackmann grade 3 had an excellent recovery of an initial palsy within the first 3 months after surgery. Hearing preservation in T1/2 schwannomas was achieved in 62.5%, in patients with T3 tumors it was 55%, and in large T4 tumors it was 25%. Three patients suffered a CSF fistula (6%), and one patient died during the perioperative period due to cardiopulmonary problems (2%).

Conclusions: The results demonstrate that with careful established educational plans in skull base surgery, excellent clinical and functional results can be achieved even by young neurosurgeons.