Clinical study of multidisciplinary treatment of large vestibular schwannomas

Abstract

Objective To design and practice standardized treatment protocols of large vestibular schwannomas (VS) based on the strategy of multidisciplinary treatment (MDT), and to discuss its clinical outcomes. Methods We analyzed all cases of unilateral large VS pathologically confirmed who underwent MDT at Department of Neurosurgery, Huashan Hospital, Fudan University from January 2010 to March 2016. Tumors with the maximal diameter longer than 3 cm were defined as large. The clinical data and follow-up results were retrospectively reviewed. A total of 266 VS patients were enrolled into this study. Electrophysiological monitoring, psychology assessment and facial nerve rehabilitation training were performed for all patients. One-stage anastomosis was applied for broken facial nerve. Results Gross total resection of the tumor was achieved in 261 patients (98.1%), near-total resection in 5 patients (1.9%), and the mortality rate was 0%. Facial nerve was anatomically preserved in 248 cases (93.2%). The function of facial nerve was evaluated according to House-Brackmann (H-B) scale, which showed that 125 patients (47.0%) were in grade Ⅰ-Ⅱ, 70 cases (26.3%) in grade Ⅲ, 71 cases (26.7%) in grade Ⅳ-Ⅵ within 1 month (short-term outcome). Perioperative complications included disequilibrium (10.1%), intracranial infection (8.6%), tinnitus (4.1%), lower cranial nerve injury (2.6%) and cerebrospinal fluid leak (1.1%). Follow-up data were available for 252 out of 266 patients (94.7%). For short-term facial outcome of 252 patients, there were 119 cases (47.2%) in grade Ⅰ-Ⅱ, 68 cases (27.0%) in grade Ⅲ, 65 cases (25.8%) in grade Ⅳ-Ⅵ. Meanwhile, long-term facial outcome showed that 184 patients (73.0%) were in grade Ⅰ-Ⅱ, 36 cases (14.3%) in grade Ⅲ, and 32 cases (12.7%) in grade Ⅳ-Ⅵ (P<0.01). There were 193 cases with serviceable hearing before surgery, of whom 60 cases showed serviceable hearing after surgery. The hearing preservation rate was 31.1%. Conclusions The MDT strategy for large VS could help improve the gross total resection rate and protect cranial nerve function. In addition, it might reduce perioperative mortality and the incidence of complications. Key words: Neuroma, acoustic; Microsurgery; Facial nerve injuries; Multidisciplinary treatment