Artikel
Interdisciplinary operative therapy of vestibular schwannoma – impact of monitoring specialists
Interdisziplinäre operative Behandlung des Akustikusneurinoms – Bedeutung eines speziellen Monitoring-Teams
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Autoren
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R. Behr
- Klinik für Neurochirurgie, Klinikum Fulda gAG
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F. Soldner
- Klinik für Neurochirurgie, Klinikum Fulda gAG
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K. Schwager
- HNO Klinik, Klinikum Fulda gAG
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: To consider the pros and cons of interdisciplinary operative treatment of Vestibular Schwannomas (VS) as a general option at any hospital and the impact of a specialized monitoring team.
Methods: Experiences and results at three different centers in collaboration with ENT- and one neurosurgeon with and without specialized monitoring technicians are described. Facial function and hearing results were evaluated pre- and postoperatively, facial function after 6 months and 1 year using the House-Brackmann (HB) scale. Hearing was evaluated by the local audiologists using the Gardner-Robertson (GR) scale. In center A and B intraoperative monitoring was performed continuously by a specialized technician, in center C by the operating team himself.
Results: The idea of working together in cases of extrameatal VS was highly appreciated by all colleagues. The number of operations increased and patients were more confident. At center A, all tumor sizes included, facial results were HB-1 63% and HB-2 33%, in 96% an excellent to good result. In center B and C were the team approach was introduced later, the results were 95% and 92% respectively. In each of both institutions one facial nerve was severed completely. Hearing preservation, independent of tumor size, in terms of GR 1–3 pre- and postoperatively was possible in center A in 57%, in B in 66% and in C in 36%. Serviceable hearing, GR 1 and 2, in tumors with an extrameatal diameter of 2 cm or less was preserved in A in 68%, in B in 80% and C in 35%. The total number of patients was 125. The team approach once established proved to be suitable and was continued. Hearing results in the center without a specialized monitoring team were worse.
Conclusions: Interdisciplinary VS operations are feasible at all institutions. The negative experience in center C with reduced rates of hearing preservation clearly shows, that the team is not only a surgical one, but must be augmented by monitoring technicians. They have to observe the recordings at any time of the operation and warn the surgeons early in case of deterioration, especially if hearing preservation is one goal of the operation.
