Surgical Outcome of Vestibular Schwannoma in a Tertiary Care Hospital, Dhaka

Abstract

Background: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression. Methods: 130 patients presented with VS who had undergone operative procedures performed in our unit from Jan, 2017 to may, 2022. The facial nerve function and hearing assessment was done according to House-Brackmann [HB] grading and pure tone audiometry (PTA) respectively. All patients were operated by retro-sigmoid retromastoid sub-occipital approach. Results: Most patients had large tumors and had no useful hearing (75.38%), had disabling cerebellar ataxia (84.61%) and presented with features of raised intracranial pressure (46.15%). Complete tumor excision was carried out 92.30% and anatomical preservation of facial nerve was achieved in 87.50% cases. Hearing preservation was achieved in eight patients. Cerebrospinal fluid leak with or without meningitis and transient lower cranial nerve paresis were common complications. The mortality rate was 7.69% Conclusions: Complete tumor excision with good facial nerve preservation can be achieved in large vestibular schwannomas. Hearing preservation is difficult in larger tumors. Primary microsurgical resection is an appropriate management option for large VS. In our experience, this goal can be achieved safely and successfully by using the retromastoid retrosigmoid sub-occipital approach. Bang. J Neurosurgery 2023; 12(2): 86-93