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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Outcome of 310 patients with vestibular schwannomas: retrospective analysis of a single institution: operative approach, outcome with respect to facial nerve- and hearing function, and complications

Retrospektive Analyse von 310 Patienten mit Vestibularisschwannom: Operativer Zugangsweg, Funktionserhalt von Hörvermögen und N.facialis, Komplikationen

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  • corresponding author G. Schackert - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • G. Reiß - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • S. B. Sobottka - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMI.01.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc216.shtml

Published: May 30, 2008

© 2008 Schackert 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.

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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.