gms | German Medical Science

Objective: For several years, there has been an ongoing debate as to whether vestibular schwannomas should be operated on or irradiated in case of progression. The risk of functional loss of the facial and the cochlear nerves is thought to be high in case of surgery. The experience of single surgeons and/or institutions, who operate routinely on vestibular schwannomas, is required.

Methods: Three-hundred and ten patients were operated at a single institution between October 1993 to March 2005. All patients were treated by a single surgeon. The surgical approach was through a suboccipital craniectomy. During the surgical procedure, the facial and the cochlear nerves were monitored. The data were evaluated with respect to preservation of facial nerve and hearing functions. Complications and recurrent tumor growth are reported.

Results: The facial nerve was anatomically preserved in 98%. A good facial function was achieved in 87.03% according to House-Brackmann Score I-III. Excellent funtion (HB I & II) was obtained in 78.3% of cases (243 patients). Hearing could be preserved in 39.65% (GR 1+2+3); GR4 in 37.5% and no hearing in 22.8%. Hearing preservation depended on the preoperative hearing level as well ason the size of the tumors. Two/thirds of the tumors were T3 and T4 tumors. Complications consisted of la CSF fistula in 6.45%, wound infection in 3.2%. The mortality rate was 0.64%. Recurrent tumor growth occurred in 2.5%.

Conclusions: Patients with vestibular schwannomas should be informed on various treatment strategies. The surgical removal of vestibular schwannomas is a safe procedure and obtains good to excellent functional results. In most cases, large T3 and T4 tumors are an indication for surgical removal, as opposed to small tumors, where alternative treatment strategies may be considered.