Ana Sayfa » Yayın Arşivi » Türk Otorinolarengoloji XXXV. Ulusal Kongre Özetleri » 2013 » Mıcrosurgery Of Vestıbular Schwannoma

Mıcrosurgery Of Vestıbular Schwannoma

Betkat J., Chovanec M., Zverina E., Profant O., Kluh J., Skrivan J., Boucek J., Kraus J., Lisy J.

OBJECTIVE:Vestibular schwannoma (VS) microsurgery underwent a considerable evolution in recent decades. Today, total microsurgical removal is very much possible with preservation of facial nerve function, and hearing preservation is even possible in selected cases. METHODS and INSTRUMENTS:333 patients with sporadic unilateral vestibular schwannoma underwent microsurgical removal between 1997 and 2012. 90% of treated tumors were grade III and grade IV tumors. Gross total removal was achieved in all but 1 case. A retrosigmoid-transmeatal approach was employed in 98%, translabyrinthine/transotic approach in 1%, and combined approach in 1% of cases. All surgeries were performed by the same multidisciplinary team with intraoperative nerve monitoring (CN VII +/- BAEP). INDICATIONS:During the follow up we diagnosed tumor recurrence in 0.6% but these cases did not necessitate any active management. We experienced 0.6% cases of periopeartive mortality. Neither meningitis nor disordered healing were observed. Medial variant of CSF leak was encountered in 0.9% and was managed with revision and leak closure. Most common complication was lateral variant of CSF leak (epidural CSF pseudocyst) with incidence of 62.5%. All such cases were managed conservatively. CN VII VII was anatomically preserved in 95% of cases. In the remaining cases we were able to perform either direct (CN VII to CN VII) or cross (CN VII to CN XII end to side) anastomosis with satisfying results. Excellent-good CN VII results were achieved in the vast majority of patients. Hearing preservation was possible in 13.5% patients merely in those with tumors grade I and II. Other neurologic (CN IX-XI palsy, disordered vestibular compensation, headaches) were encountered in minority of patients. To minimize postoperative and disease specific handicap we introduced several algorithms (e.g. Endoscopy assisted and minimally invasive surgery, BAHA implantation for single sided deafness, biofeedback and prehabituation to speed up vestibular compensation). RESULT:Despite significant advances (e.g., in microsurgery, neuroanesthesia, cranial nerve monitoring, imaging methods) today the goals of vestibular schwannoma treatment remain unchanged: preservation of life, radical removal, and anatomic and functional preservation of n. VII. Preservation of serviceable hearing is even possible in selected cases. However, goals of vestibular schwannoma management should be aimed at both prevention of complications, and disease and surgery related consequencies reducing the quality of life. Acknowledgement: IGA MZCR projects no. NT/11543-6 and NT/12459-5.

Türk Otorinolarengoloji XXXV. Ulusal Kongre Özetleri SS-236

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