A Journey Through 100 Years of Vestibular Schwannoma Surgery at Mayo Clinic: A Historical Illustrative Case Series

Abstract

The present state of vestibular schwannoma (VS) management is the product of over a century of technical progress by revolutionary surgeons who transformed a once perilous operation. At the beginning of the 1900s, patients who did not succumb to their disease were treated exclusively with surgery, which itself was almost assuredly devastating. Through the pioneering work of surgeons such as Harvey Cushing, Walter Dandy, William House, and others, safer surgical approaches were established with concurrent advances in neuromonitoring, neuroanesthesia, radiology, and adoption of the operating microscope. Owing to refinements in radiosurgical treatment and a greater understanding of the natural history of disease, there has been a dramatic shift toward more conservative management in recent years. For more than 100 years, the Mayo Clinic in Rochester, MN, has maintained an active and uninterrupted VS practice with activities that are well documented and preserved through the Mayo Clinic historical archives. We herein report representative early cases to illustrate the fascinating evolution in VS surgery over the past century at a single-tertiary referral center. Original clinical, imaging, pathology, and operative reports are presented from each era of management. To accurately portray the medical context of each era, antiquated terminology is intentionally preserved as originally transcribed.

Repeat Radiosurgery for Sporadic Vestibular Schwannoma After Primary Radiosurgical Failure: An International Multi-institutional Investigation

“…The remaining 2 (6%) patients underwent SRS with CyberKnife (CK; Accuray, Sunnyvale, CA), both of whom received 3 fractions with a maximum dose of 23 and 24 Gy, respectively, and a marginal dose of 18 Gy. Median tumor volume was 0.970 cm 3 (IQR, 0.372-3.500 cm 3 ), and median number of isocenters for GK was 8.5 (IQR, 5-13). There were no major complications such as stroke or hydrocephalus within 30 days of primary SRS (Table 2).…”

“…Since Lars Leksell first described gamma knife (GK) stereotactic radiosurgery (SRS) in the 1950s, this modality has been increasingly used for management of sporadic vestibular schwannoma (VS), with an estimated 125,000 cumulative cases treated with GK from 1968 to 2019 (1)(2)(3)(4). Recent studies estimate that 25 to 30% of small-to medium-sized sporadic VS are now treated with primary SRS (5).…”

The Effect of Age on Facial Nerve Recovery After Vestibular Schwannoma Resection

“…As microsurgical techniques and intraoperative neuromonitoring for vestibular schwannoma (VS) have advanced, surgeons and patients have placed extraordinary effort and weight on the maintenance of facial nerve function (1,2). The motivation to achieve good facial nerve function with microsurgery has been further pushed by the generally excellent outcomes reported for conventional low-dose stereotactic radiosurgery and active surveillance.…”