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Minim Invasive Neurosurg 2006; 49(6): 362-368
DOI: 10.1055/s-2006-955068
Original Article

© Georg Thieme Verlag KG · Stuttgart · New York

A Series of 112 Fully Endoscopic Resections of Vestibular Schwannomas

M. S. Kabil 1 , H. K. Shahinian 1
  • 1Skull Base Institute, Los Angeles, CA, USA
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Publication History

Publication Date:
23 February 2007 (online)

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Abstract

We report a consecutive series of 112 patients with unilateral vestibular schwannoma (VS) having undergone fully endoscopic resection of their tumors in the period from October, 2001 to January, 2005. Patients' outcomes were evaluated especially with regards to cochlear nerve (hearing) preservation, facial nerve preservation, postoperative complications and completeness of the resection. The patient population consisted of 112 consecutive cases with unilateral, “de novo” VS(s); patients with neurofibromatosis type 2 (NFT2) or with a recurrent tumor were excluded from this study. Tumors ranged in size from 0.6-5.7 cm, most tumors were less than 3 cm in diameter (mean: 2.6 cm). This shift towards smaller and also less symptomatic tumors may be due to an increase in the awareness of patients and earlier detection of their tumors (MRI era). Tumors were removed via 1.5-cm “keyhole” retrosigmoid craniotomies. Utilizing the fully endoscopic technique, 106/112 (95%) tumors were completely removed; subtotal removal was performed in 6/112 (5%) patients in an attempt to preserve their hearing. Anatomic preservation of the facial nerve was achieved in all of the patients and of the cochlear nerve in 83/101 (82%) hearing ears. Functionally, measurable hearing (serviceable/some) was preserved in 59/101 (58%) cases who had either “serviceable” or “some” hearing preoperatively, 2 patients who had “some” hearing preoperatively had an improvement that was more than 30 db in their hearing postoperatively. There were no major neurological complications such as quadriparesis, hemiparesis, bacterial or aseptic meningitis, lower cranial nerve deficits, or deaths. From our experience, we conclude that the endoscope is ideally suited for a minimally invasive approach for the resection of vestibular schwannomas.

Key words

Endoscopic - acoustic neuroma - vestibular schwannoma

References

  • 1 Shiffman F, Dancer J, Rothballer AB, Berrett A, Baum S. The diagnosis and evaluation of acoustic neuromas.  Otolaryngol Clin North Am. 1973;  6 189-228
    PubMedSearch in Google Scholar
  • 2 Lanser MJ, Sussman SA, Frazer K. Epidemiology, pathogenesis, and genetics of acoustic tumors.  Otolaryngol Clin North Am. 1992;  25 499-520
    PubMedSearch in Google Scholar
  • 3 Rosenberg SI. Natural history of acoustic neuromas.  Laryngoscope. 2000;  110 497-508
    CrossrefPubMedSearch in Google Scholar
  • 4 Acoustic Neuroma National Institutes of Health Consensus Development Conference on Acoustic Neuroma.  National Institutes of Health. 1991;  1-24
    PubMedSearch in Google Scholar
  • 5 Nager GT. Acoustic neurinomas.  Acta Otolaryngol (Stockh). 1985;  99 245-261
    CrossrefPubMedSearch in Google Scholar
  • 6 Tos M, Charabi S, Thomsen J. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results.  Eur Arch Otorhinolaryngol. 1998;  255 1-6
    CrossrefPubMedSearch in Google Scholar
  • 7 Selesnick SH, Jackler RK. Clinical manifestations and audiologic diagnosis of acoustic neuromas.  Otolaryngol Clin N Am. 1992;  25 521-551
    PubMedSearch in Google Scholar
  • 8 Cushing H. Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontine Angle. W.B. Saunders, Philadelphia/London 1917
  • 9 Erickson DL, Ausman JI, Chou SN. Prognosis of VIIth nerve patsy following removal of large acoustic tumors. J Neurosurg. 1977;  47 31-34
    PubMedSearch in Google Scholar
  • 10 Low WK. Enhancing hearing preservation in endoscopic-assisted excision of acoustic neuroma via the retrosigmoid approach.  J Laryngol Otol. 1999;  113 973-977
    PubMedSearch in Google Scholar
  • 11 Magnan J, Barbieri M, Mora R, Murphy S, Meller R, Bruzzo M, Chays A. Retrosigmoid approach for small and medium-sized acoustic neuromas.  Otol Neurotol. 2002;  23 141-145
    CrossrefPubMedSearch in Google Scholar
  • 12 Eby JBC, Shahinian HK. Fully endoscopic vascular decompression of the facial nerve for hemifacial spasm.  Skull Base: An Interdisciplinary Approach. 2001;  11 189-196
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Jarrahy R, Berci G, Shahinian HK. Endoscope-assisted microvascular decompression of the trigeminal nerve.  Otolaryngol Head Neck Surg. 2000;  123 218-223
    CrossrefPubMedSearch in Google Scholar
  • 14 Jarrahy R, Cha ST, Berci G, Shahinian HK. Fully endoscopic vascular decompression of the glossopharyngeal nerve.  J Craniofacial Surg. 2002;  13 90-95
    CrossrefPubMedSearch in Google Scholar
  • 15 Jarrahy R, Eby JB, Cha ST, Shahinian HK. Fully endoscopic vascular decompression of the trigeminal nerve.  Minim Invas Neurosurg. 2002;  45 32-35
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Kabil MS, Shahinian HK. A series of 112 fully endoscopic resections of vestibular shwannomas.  Neurosurgery. 1997;  41 50-61
    CrossrefPubMedSearch in Google Scholar
  • 17 House J, Brachman DE. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
    Search in Google Scholar
  • 18 Robinette MS, Bauch CD, Olsen WO, Cevette MJ. Auditory brainstem response and magnetic resonance imaging for acoustic neuromas.  Arch Otolaryngol Head Neck Surg. 2000;  126 963-966
    CrossrefPubMedSearch in Google Scholar
  • 19 Curtin HD, Hirsch WL. Imaging of acoustic neuromas.  Otolaryngol Clin North Am. 1992;  25 553-607
    PubMedSearch in Google Scholar
  • 20 Driscoll CL, Lynn SG, Harner G, Beatty CW, Atkinson EJ. Preoperative identification of patients at risk of developing persistent dysequilibrium after acoustic neuroma removal.  Am J Otol. 1998;  19 491-495
    PubMedSearch in Google Scholar
  • 21 Ramsay HA, Luxford WM. Treatment of acoustic tumours in elderly patients: is surgery warranted?.  J Laryngol Otol. 1993;  107 295-297
    PubMedSearch in Google Scholar
  • 22 House WF. Monograph I: transtemporal bone microsurgical removal of acoustic neurinomas.  Arch Otolaryngol. 1964;  80 597-756
    PubMedSearch in Google Scholar
  • 23 Drake CG. Total removal of large acoustic neuromas.  J Neurosurg. 1967;  26 554-561
    PubMedSearch in Google Scholar
  • 24 Rand R, Kurze T. Preservation of vestibular, cochlear and facial nerves during microsurgical removal of acoustic tumors: report of two cases.  J Neurosurg. 1968;  28 158-161
    PubMedSearch in Google Scholar
  • 25 Cohen NL. Retrosigmoid approach for acoustic tumor removal.  Otolaryngol Clin North Am. 1992;  25 295-310
    PubMedSearch in Google Scholar
  • 26 Hardy DG, MacFarlane R, Baguley D, Moffat DA. Surgery for acoustic neuroma. An analysis of 100 translabyrinthine operations.  J Neurosurg. 1989;  71 799-804
    CrossrefPubMedSearch in Google Scholar
  • 27 Axon PR, Ramsden RT. Facial nerve injury caused by vestibular schwannoma compression: severity and adaptation to maintain normal clinical facial function.  Am J Otol. 1999;  20 763-769
    PubMedSearch in Google Scholar
  • 28 Post KD, Eiseaberg M, Catalano P. Hearing preservation in vestibular schwannoma surgery: what factors influence the outcome?.  J Neurosurg. 1995;  83 191-196
    Search in Google Scholar
  • 29 Samii M, Matthies C. Management of 1000 vestibular schwannomas: surgical management and results.  Neurosurgery. 1997;  40 11-23
    PubMedSearch in Google Scholar
  • 30 Tos M, Thomsen J, Harmsen A. Is preservation of hearing acoustic neuroma worthwhile?.  Acta Otolaryngol (Stockh). 1988;  452 57-68
    PubMedSearch in Google Scholar
  • 31 Wiet RJ, Teixido M, Liang JG. Complications in acoustic neuroma surgery.  Otolaryngol Clin North Am. 1992;  125 389-412
    PubMedSearch in Google Scholar
  • 32 Selesnick SH, Deora M, Drotman MB, Heier LA. Incidental discovery of acoustic neuromas.  Otolaryngol Head Neck Surg. 1999;  120 815-818
    CrossrefPubMedSearch in Google Scholar
  • 33 Horrax G, Poppen JL. The end results of complete versus intracapsular removal of acoustic tumors.  Ann Surg. 1949;  130 567-575
    CrossrefPubMedSearch in Google Scholar
  • 34 Cohen NL, Ransohoff J. Hearing preservation: posterior fossa approach.  Otolaryngol Head Neck Surg. 1984;  92 176-183
    PubMedSearch in Google Scholar

Correspondence

Hrayr K. ShahinianM.D., FACS 

Skull Base Institute

8635 West Third Street, Suite 1170W

Los Angeles, CA 90048

USA

Phone: +1/310/691 88 88

Fax: +1/310/691 88 77

Email: team@skullbaseinstitute.com