OBJECT: The authors evaluated the outcome of radical surgery in a consecutive series of patients with giant vestibular schwannomas (VSs). METHODS: Fifty patients with VSs > 4.0 cm in maximal extrameatal diameter were included in this retrospective study (Group A). The group was compared with a matched group of 167 patients with VSs < 3.9 cm (Group B). In all cases the retrosigmoid approach was used. Outcome measures included completeness of tumor removal, facial nerve function, hearing, and the surgery-related complication rate. RESULTS: The mean tumor size in Group A was 4.4 cm and that in Group B was 2.3 cm. Total removal was achieved in all Group A patients and in 97.6% of Group B patients. The anatomical integrity of the facial nerve was preserved in 92% in Group A and in 98.8% in Group B. At last follow-up 75% of the patients with giant VSs had excellent or good facial nerve function, 19% had fair function, and 6% had poor function. In 33% of patients (3 cases) with good preoperative hearing level, it was preserved. Newly developed lower cranial nerve dysfunction occurred in 3 patients but proved to be temporary in 2 of them. A CSF leak developed in 6% of those who not previously undergone surgery. Compared with Group B, a significant difference was found only in the rates of the following parameters: excellent facial nerve function, useful and good hearing, lower cranial nerve dysfunction, and blood collection (p < 0.05). The perioperative mortality rate in both groups was 0%. CONCLUSIONS: In patients with a giant VS, total tumor removal can be achieved via the retrosigmoid approach with a 0% mortality rate and low morbidity rate, especially with regards to facial nerve function. In selected cases even hearing preservation is possible. Tumor size significantly correlates with postoperative outcome.
OBJECT: The authors evaluated the outcome of radical surgery in a consecutive series of patients with giant vestibular schwannomas (VSs). METHODS: Fifty patients with VSs > 4.0 cm in maximal extrameatal diameter were included in this retrospective study (Group A). The group was compared with a matched group of 167 patients with VSs < 3.9 cm (Group B). In all cases the retrosigmoid approach was used. Outcome measures included completeness of tumor removal, facial nerve function, hearing, and the surgery-related complication rate. RESULTS: The mean tumor size in Group A was 4.4 cm and that in Group B was 2.3 cm. Total removal was achieved in all Group A patients and in 97.6% of Group B patients. The anatomical integrity of the facial nerve was preserved in 92% in Group A and in 98.8% in Group B. At last follow-up 75% of the patients with giant VSs had excellent or good facial nerve function, 19% had fair function, and 6% had poor function. In 33% of patients (3 cases) with good preoperative hearing level, it was preserved. Newly developed lower cranial nerve dysfunction occurred in 3 patients but proved to be temporary in 2 of them. A CSF leak developed in 6% of those who not previously undergone surgery. Compared with Group B, a significant difference was found only in the rates of the following parameters: excellent facial nerve function, useful and good hearing, lower cranial nerve dysfunction, and blood collection (p < 0.05). The perioperative mortality rate in both groups was 0%. CONCLUSIONS: In patients with a giant VS, total tumor removal can be achieved via the retrosigmoid approach with a 0% mortality rate and low morbidity rate, especially with regards to facial nerve function. In selected cases even hearing preservation is possible. Tumor size significantly correlates with postoperative outcome.
Authors: Christopher S Graffeo; Avital Perry; Aditya Raghunathan; Trynda N Kroneman; Mark Jentoft; Colin L Driscoll; Brian A Neff; Matthew L Carlson; Jeffrey Jacob; Michael J Link; Jamie J Van Gompel Journal: J Neurol Surg B Skull Base Date: 2018-02-07
Authors: Roy Thomas Daniel; Constantin Tuleasca; Alda Rocca; Mercy George; Etienne Pralong; Luis Schiappacasse; Michele Zeverino; Raphael Maire; Mahmoud Messerer; Marc Levivier Journal: J Neurol Surg B Skull Base Date: 2018-08-23
Authors: M Castellaro; M Moretto; V Baro; S Brigadoi; E Zanoletti; M Anglani; L Denaro; R Dell'Acqua; A Landi; F Causin; D d'Avella; A Bertoldo Journal: AJNR Am J Neuroradiol Date: 2020-07-30 Impact factor: 3.825
Authors: Nolan Ung; Monica Mathur; Lawrance K Chung; Nicole Cremer; Panayiotis Pelargos; Andrew Frew; Kimberly Thill; Ishani Mathur; Brittany Voth; Michael Lim; Isaac Yang Journal: J Neurol Surg B Skull Base Date: 2016-01-04