Surgical Treatment of Sporadic Vestibular Schwannoma in a Series of 1006 Patients

Overview

Journal Acta Otorhinolaryngol Ital

Specialty Otorhinolaryngology

Date 2016 Sep 8

PMID 27600105

Citations 9

Authors

Z Zhang

Y Nguyen

D De Seta

F Y Russo

A Rey

M Kalamarides

O Sterkers

D Bernardeschi

Affiliations

Soon will be listed here.

Abstract

The management of sporadic vestibular schwannoma (VS) has evolved in the last decades. The aim of this study was to analyse the evolution in surgical outcomes of VSs operated by a neurotological team between 1990 and 2006 by different approaches. A monocentric retrospective review of medical charts of 1006 patients was performed. In order to assess eventual changes and progress, the 17-years period was divided in three periods, each one comprehending 268 VS (1990-1996), 299 VS (1997-2001), and 439 VS (2002-2006). Mean follow-up was 5.9 ± 2.4 years. Overall, complete VS removal was achieved in 99.4% of cases. Mortality rate was 0.3%, meningitis and CSF leaks were observed in 1.2 % and 9 % of the cases, respectively. CSF leakage decreased from 11.6% to 7.1% between the first and last period (p < 0.01) as well as revision surgery from 3.4 % to 0.9 % (p < 0.05). Facial nerve was anatomically preserved in 97.7% of cases. At one year, a good facial nerve function was observed in 85.1% of patients (grade I and II of House-Brackmann grading scale), which ranged between the first and last period from 78.4% to 87.6% (p <0.05). At one year, hearing preservation was obtained in 61.6% of patients, which increased from the first period to the last one from 50.9% to 69.0% (p < 0.05) (class A+B+C from the AAO-HNS classification). Useful hearing (class A+B) was observed in 33.5% of cases overall, with 21.8% and 42% in the first and last period, respectively (p < 0.01). Surgical outcomes of sporadic vestibular schwannoma have improved concerning facial nerve function outcomes, hearing preservation and cerebrospinal fluid (CSF) leaks, mainly due to the neuro-otological team's experience. Functional results after complete microsurgical removal of large VS depend on experience gained on small VS removal.

Citing Articles

Outcomes in Vestibular Schwannoma Surgery: insights from our last 100 cases.

Hudelist B, Alciato L, Bernardeschi D, Kalamarides M Neurosurg Rev. 2025; 48(1):122.

PMID: 39888532 DOI: 10.1007/s10143-025-03239-0.

Posterior location of the facial nerve on vestibular schwannoma: Report of a rare case and a literature review.

Bahuleyan B, Patel V, Anto M, Hessel S, Ramesh R, Girish K Surg Neurol Int. 2024; 15:345.

PMID: 39372978 PMC: 11450832. DOI: 10.25259/SNI_586_2024.

Temporal lobe injury with middle fossa approach to intracanalicular vestibular schwannomas: a systematic review.

Flores-Milan G, Rainone G, Piper K, Peto I, Danner C, Allen K Neurosurg Rev. 2024; 47(1):188.

PMID: 38658423 DOI: 10.1007/s10143-024-02425-w.

Management of sporadic intracanalicular vestibular schwannomas: A critical review and International Stereotactic Radiosurgery Society (ISRS) practice guidelines.

Balossier A, Sahgal A, Kotecha R, Fariselli L, Gorgulho A, Levivier M Neuro Oncol. 2023; 26(3):429-443.

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Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 1: The Retrosigmoid Approach.

Layard Horsfall H, Khan D, Collins J, Cooke S, Freeman S, Gurusinghe N J Neurol Surg B Skull Base. 2023; 84(5):423-432.

PMID: 37671298 PMC: 10477012. DOI: 10.1055/a-1886-5500.

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