gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Functional outcome after microsurgery for vestibular schwannomas

Meeting Abstract

  • A. Rizk - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • G. Lepski - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • F. Ebner - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • F. Roser - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • M. Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.12.06

DOI: 10.3205/12dgnc271, URN: urn:nbn:de:0183-12dgnc2714

Published: June 4, 2012

© 2012 Rizk et al.
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Outline

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Objective: The aim of this study was to evaluate the functional outcome after microsurgical treatment for vestibular schwannomas (VS).

Methods: The authors performed a retrospective study of 269 consecutive patients presenting with VS who underwent surgical treatment between March 2004 and October 2010. Neurofibromatosis patients, recurrent tumors, and irradiated tumors have been excluded. Mean follow-up period is 15.5 months. Patient records, operative videos, electrophysiological assessment, and neuroradiological findings were retrospectively analyzed. The main outcome measures were patient complaints, functional neurological status, resection grade on MRI, and surgical complications. Results were compared with those reported in the literature.

Results: Complete tumor removal was achieved in 97.4% of patients. Anatomical preservation of the facial nerve was possible in 98.5% of patients. The facial nerve was not preserved in 4 patients who presented class 4 tumors according to the Hannover classification. Tumor extension significantly affected facial nerve function (P value < 0.001). Three months after surgery, 84.4% of patients had good facial nerve function (HB Grade I or II). By the last follow-up examination, good facial nerve function had been achieved in 91.8% of the cases, and in 96.9% of patients having tumors with extension Classes T1, T2, and T3. The rate of anatomical preservation of the cochlear nerve was 94.2% in the patients presenting functional hearing preoperatively (GR Grade I or II). Nevertheless, functional hearing was preserved in 58.5% of the patients in this category; moreover, we observed a clear correlation between hearing preservation and tumor extension (P value < 0.001). Hearing preservation was possible in 72.6% of patients with tumor classes T1, T2, and T3a. Trigeminal symptoms and vertigo improved in 100% and 90.7% of the cases, respectively. There was no mortality in this series. Cerebrospinal fluid leakage occurred in 6.7% of the patients, but surgical revision was necessary only in 1%.

Conclusions: Microsurgery is a safe treatment modality for VS, irrespective of its size. Based on the literature, functional results are comparable to those after irradiation.