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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Functional outcome after microsurgery for previously treated vestibular schwannomas

Meeting Abstract

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  • Guilherme Lepski - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
  • Florian Ebner - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
  • Ahmed Rizk - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
  • Florian Roser - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
  • Marcos Tatagiba - Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 016

doi: 10.3205/14dgnc411, urn:nbn:de:0183-14dgnc4113

Published: May 13, 2014

© 2014 Lepski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The aim of this study was to evaluate the functional outcome after microsurgery for previously treated vestibular schwannomas (VS), either through surgery or irradiation.

Method: The authors performed a retrospective study of 21 patients presented with recurrent and /or previously irradiated VS who underwent surgical treatment between 2006 and 2011. Follow-up ranged from 4 to 29 months (mean 11.6 months). Patients' 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: 8 patients had been submitted to irradiation only, 9 patients had been previously operated, and 4 patients had been submitted to surgery and irradiation. Complete tumor removal was achieved in 81% of patients. Overall, anatomical preservation of the facial nerve was possible in 71.4% of the cases. Analyzing separately, the facial nerve was anatomically preserved in all irradiated cases, in 66% of the operated cases, and only in 25% of the cases submitted to surgery and irradiation (p<0.05). By the last follow-up examination, good facial nerve function (HB Grade I or II) had been achieved in 42.8% of the cases. Moreover, facial nerve function was statistically better in the irradiated group, compared to the operated one (p<0.05) and to both treatments combined (p<0.05) at the last follow-up. Hearing was non-serviceable in all previously operated patients; however, two out of eight irradiated patients still presented serviceable hearing. The cochlear nerve was anatomically preserved in both patients; however hearing was preserved in only one. There was no mortality in this series. One patient developed temporary swallowing problems. Three patients developed CSF leakage.

Conclusions: Previous treatment of VS significantly affects the functional outcome after surgery, especially regarding preservation of facial nerve function. Nevertheless, previous surgery represents the most important isolated factor