Small Vestibular Schwannomas: Does Surgery Remain a Viable Treatment Option?

被引:16
作者
Anaizi, Amjad N. [1 ,2 ,3 ]
DiNapoli, Vincent V. [1 ,2 ]
Pensak, Myles [2 ,4 ]
Theodosopoulos, Philip V. [1 ,2 ,5 ,6 ]
机构
[1] Univ Cincinnati, Coll Med, Dept Neurosurg, Cincinnati, OH 45267 USA
[2] UC Neurosci Inst, Brain Tumor Ctr, Cincinnati, OH USA
[3] Georgetown Univ, Dept Neurosurg, Washington, DC USA
[4] Univ Cincinnati, Coll Med, Dept Otolaryngol Head & Neck Surg, Cincinnati, OH USA
[5] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA
[6] Mayfield Clin, Cincinnati, OH USA
关键词
acoustic neuroma; disequilibrium; hearing preservation; vestibular dysfunction; outcomes; facial nerve function; dizziness; quality of life; GAMMA-KNIFE RADIOSURGERY; FACIAL-NERVE FUNCTION; LONG-TERM OUTCOMES; INTRACANALICULAR ACOUSTIC NEUROMAS; STEREOTACTIC RADIOSURGERY; RETROSIGMOID APPROACH; CLINICAL ARTICLE; MIDDLE FOSSA; HEARING PRESERVATION; CONSERVATIVE MANAGEMENT;
D O I
10.1055/s-0035-1564591
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Surgery for small vestibular schwannomas (Koos grade I and II) has been increasingly rejected as the optimal primary treatment, instead favoring radiosurgery and observation that offer lower morbidity and potentially equal efficacy. Our study assesses the outcomes of contemporary surgical strategies including tumor control, functional preservation, and implications of pathologic findings. Design Retrospective review. Setting/Participants Eighty consecutive patients (45 women, 35 men; mean: 47 years of age). Main Outcomes Measures Approaches included retrosigmoid approach (52%), translabyrinthine (40%), and middle fossa (8%). Operated on by the same surgical team, we analyzed presentation, radiographic imaging, surgical data, and outcomes. Results At last follow-up (mean: 34 months), 95% had good facial nerve function (House-Brackmann grade I or II); 36% who presented with serviceable hearing retained it; and 93% who presented with vestibular dysfunction reported resolution. Pathology identified two grade I meningiomas. Conclusions As one of the largest contemporary surgical series of small vestibular schwannomas, we discuss some nuances to help refine treatment algorithms. Although observation and radiosurgery have established roles, our results reinforce microsurgery as a viable, safe option for a subgroup of patients.
引用
收藏
页码:212 / 218
页数:7
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