Artikel
Vestibular schwannoma surgery during the last 80 years – Technological advancements and the pioneers
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Autoren
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Marcos Tatagiba
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Florian H. Ebner
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: To report about the technological development and the pioneers who sustainably influenced vestibular schwannoma surgery over the last 80 years.
Methods: Literature review with the key words “vestibular schwannoma”, “history”, “technological advancement”
Results: Going 80 years back the analysis starts in AD 1937- the year of death of Fedor Krause. In the post Fedor Krause era, Walter E.Dandy further improved the technique performing a capsular dissection via an unilateral suboccipital approach. Thus he achieved complete tumor resection with a markedly reduced mortality rate both in the perioperative and follow-up period.
Murray et al. proved in 1944 the Schwann cell being the origin of the nerve sheath tumor. Steward and Schuknecht identified the neurilemmal-glia junction as site of origin in 1975.
In 1957 Theodor Kurze first operated a VS under microscopic visualization using the retrosigmoid route. Further development and refinement of the microsurgical technique led to the concept of facial and thereafter hearing preservation. William House applied microsurgical techniques to the translabyrinthine approach achieving excellent results in terms of facial nerve preservation rates. Introduction of ultrasonic aspirator for tumor debulking and intraoperative monitoring for continuous surveillance of cranial nerve function represent essential steps towards a new era in VS surgery. Sugita and Kobayashi reported in 1982 about the usefulness of the bipolar forceps for stimulating the facial nerve and thus facial nerve monitoring. Thereafter monitoring of brain stem evoked potentials was introduced. House and Hitselberger were pioneers in the development of auditory brainstem implants. Cochlear implants and auditory brainstem implants opened up the era of hearing restoration, a field in continuous development.
A further milestone was the understanding of the microsurgical anatomy. Prof.Johannes Lang rendered outstanding services to the knowledge of microsurgical anatomy of the cerebellopontine angle as well as A.L. Rhoton in the following years. Professor Madjid Samii contribution to the field of vestibular schwannoma surgery is outstanding. He brought operative strategy and microsurgical technique as well as perioperative management to perfection. In large patient series with excellent results he gave proof of the revolution in VS microsurgery that took place over the last 80 years.
Conclusion: Great success has been achieved - and still a lot has to be done. Advances in medical engineering, molecular biology and regenerative research will open new horizons in the microsurgical treatment of patients with VS.
