The first 50s: can we achieve acceptable results in vestibular schwannoma surgery from the beginning?

Abstract

Vestibular schwannoma surgery requires a profound knowledge of anatomy and long-standing experience of surgical skull base techniques, as patients nowadays requests high-quality results from any surgeon. This educes a dilemma for the young neurosurgeon as she/he is at the beginning of a learning curve. The presented series should prove if surgical results of young skull base surgeons are comparable respecting carefully planned educational steps. The first 50 vestibular schwannomas of the first author were retrospectively evaluated concerning morbidity and mortality with an emphasis on functional cranial nerve preservation. The results were embedded in a timeline of educational steps starting with the internship in 1999. Fifty vestibular schwannomas were consecutively operated from July 2007 to January 2010. According to the Hannover Classification, 14% were rated as T1, 18% as T2, 46% as T3, and 21% as T4. The overall facial nerve preservation rate was 96%. Seventy-nine percent of patients with T1-T3 tumours had no facial palsy at all and 15% had an excellent recovery of an initial palsy grade 3 according to the House & Brackman scale within the first 3 months after surgery. Hearing preservation in T1/2 schwannomas was achieved in 66%, in patients with T3 tumours in 56%, and in large T4 tumours in 25%. Three patients suffered a cerebrospinal fluid fistula (6%), and one patient died during the perioperative period due to cardiopulmonary problems (2%). The results demonstrate that with careful established educational plans in skull base surgery, excellent clinical and functional results can be achieved even by young neurosurgeons.