Abstract
BackgroundVestibular schwannoma (VS) is a benign tumor originating from the vestibulocochlear nerve. The optimal treatment strategy is debated, since surgery may result in iatrogenic facial nerve injury. We report the results of VS surgery in a population-based unselected cohort in a center with access to Cyber Knife (CK) radiosurgery.MethodsWe reviewed 117 consecutive operations and found 95 patients who had their primary operation due to vestibular schwannoma between 2001 and 2017. Facial nerve function was evaluated with the House-Brackmann (HB) scale and hearing with the EU classification.ResultsThe population consisted of 37 males and 58 females with a median age of 54 years (range 19–79). One year after surgery 67% of patients had a good outcome (HB 1–2). The rate of good outcome was 90% if no facial nerve damage was observed during intraoperative monitoring, the size of the tumor was under 30 mm and no hydrocephalus was present. During the study period, the treatment strategy changed from total to near-total resection after the introduction of CK radiosurgery, which could be used as a second-line treatment in case of residual tumor regrowth. This resulted in an improvement of outcomes (0% HB 5–6) despite the larger tumor sizes (25 ± 14 mm vs. 31 ± 9 mm, p < 0.05). Hearing preservation rates did not increase.ConclusionsNear-total resection and subsequent CK radiosurgery in case of residual tumor regrowth during follow-up seems to provide a good outcome of facial nerve function even in large VSs.
Highlights
This article is part of the Topical Collection on Tumor - SchwannomaVestibular schwannoma (VS), previously called acoustic neuroma, is a benign, slow-growing tumor originating from the Schwann cells of the vestibular branch of the vestibulocochlear nerve [17]
The aim of the current study is to evaluate facial nerve function in a population-based series of consecutive patients operated for VS with intraoperative neurophysiological monitoring between the years 2001 and 2017
Nine patients with neurofibromatosis type 2, six patients with schwannomas of other than VIII cranial nerve were excluded from the analyses
Summary
Vestibular schwannoma (VS), previously called acoustic neuroma, is a benign, slow-growing tumor originating from the Schwann cells of the vestibular branch of the vestibulocochlear nerve [17]. The annual incidence of VS is 1–2:100,000 making it the third most common benign intracranial tumor. The cerebellopontine angle (CPA), VS is the most common type of tumor [25, 30, 37, 50]. The typical symptoms of VSs are caused by compression on the adjacent cranial nerves and may present as hearing loss, tinnitus, dizziness, facial numbness or weakness. Vestibular schwannoma (VS) is a benign tumor originating from the vestibulocochlear nerve. The optimal treatment strategy is debated, since surgery may result in iatrogenic facial nerve injury. Facial nerve function was evaluated with the House-Brackmann (HB) scale and hearing with the EU classification
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