Article

Functional outcome after complete surgical removal of giant vestibular schwannomas.

International Neuroscience Institute, Hannover, Germany.
Journal of Neurosurgery (impact factor: 2.96). 08/2009; 112(4):860-7. DOI:10.3171/2009.7.JNS0989 pp.860-7
Source: PubMed

ABSTRACT The authors evaluated the outcome of radical surgery in a consecutive series of patients with giant vestibular schwannomas (VSs).
Fifty patients with VSs > 4.0 cm in maximal extrameatal diameter were included in this retrospective study (Group A). The group was compared with a matched group of 167 patients with VSs < 3.9 cm (Group B). In all cases the retrosigmoid approach was used. Outcome measures included completeness of tumor removal, facial nerve function, hearing, and the surgery-related complication rate.
The mean tumor size in Group A was 4.4 cm and that in Group B was 2.3 cm. Total removal was achieved in all Group A patients and in 97.6% of Group B patients. The anatomical integrity of the facial nerve was preserved in 92% in Group A and in 98.8% in Group B. At last follow-up 75% of the patients with giant VSs had excellent or good facial nerve function, 19% had fair function, and 6% had poor function. In 33% of patients (3 cases) with good preoperative hearing level, it was preserved. Newly developed lower cranial nerve dysfunction occurred in 3 patients but proved to be temporary in 2 of them. A CSF leak developed in 6% of those who not previously undergone surgery. Compared with Group B, a significant difference was found only in the rates of the following parameters: excellent facial nerve function, useful and good hearing, lower cranial nerve dysfunction, and blood collection (p < 0.05). The perioperative mortality rate in both groups was 0%.
In patients with a giant VS, total tumor removal can be achieved via the retrosigmoid approach with a 0% mortality rate and low morbidity rate, especially with regards to facial nerve function. In selected cases even hearing preservation is possible. Tumor size significantly correlates with postoperative outcome.

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Keywords

0% mortality rate
 
CSF leak
 
excellent facial nerve function
 
facial nerve function
 
following parameters
 
giant VSs
 
good facial nerve function
 
Group B patients
 
low morbidity rate
 
lower cranial nerve dysfunction
 
matched group
 
mean tumor size
 
Outcome measures
 
perioperative mortality rate
 
postoperative outcome
 
radical surgery
 
surgery-related complication rate
 
Total removal
 
total tumor removal
 
tumor removal