Surgical Policy of Bilateral Vestibular Schwannomas

Abstract

Bilateral vestibular schwannomas (VSs) are rare intracranial tumors. Most patients in India present late, with larger tumors and disabling deafness. Clinical presentation and management prospective are also diverse. The aims of the study were (1) to report the differences in clinical presentations and surgical results of bilateral VSs in contrast to unilateral VSs, and (2) to propose a management strategy for these tumors with reference to the tumor extent and size and the presence or absence of hearing disability. Sixteen cases of bilateral VSs were analyzed and treated over 10 years at the Sanjay Gandhi Post Graduate Institute of Medical Sciences. All patients were evaluated with respect to demographic profile; facial nerve grading; hearing disability; and estimation of the tumor size, volume, and extent. Management strategy was carried out according to Samii's classification of tumor extent and the amount of hearing loss status. All surgeries were performed by the retromastoid suboccipital approach. Postoperative results were analyzed and compared with those of unilateral VS. The mean age of presentation was 25.7 years. Hearing impairment was the most common symptom. Headache with features of raised intracranial pressure was present in 10 (62.5%) patients. According to the size of the larger tumors, giant tumors were present in seven (43.7%) patients, larger tumors in eight (50%) patients, and medium-size tumor in one (6.3%). Total tumor resection was achieved in 13 patients, and 2 had subtotal resection. One patient was managed conservatively and followed up with serial CT scans. On the contralateral side, one large tumor required total excision. One medium-size tumor underwent subcapsular excision in an attempt to preserve hearing. The facial nerve was anatomically preserved in seven (46.7%) patients; in one, the cochlear nerve was anatomically preserved. There was no perioperative mortality.