Contemporary management of acoustic neuromas

Theodosopoulos, Philip V.; Pensak, Myles L.

doi:10.1002/lary.21799

Cited by 53 publications

(36 citation statements)

References 62 publications

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“…All vestibular schwannomas are managed in a multi-disciplinary team setting with decisions dependent on size of the tumour, the extent of hearing loss, patient co-morbidities and preferences. The principal aim is to minimise morbidity, preserving functions of surrounding structures, particularly the facial nerve [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Tumour Resection Volumes and Facial Nerve Outcomes for Vestibular Schwannomas

Virk

Tripathi

Randhawa

et al. 2014

Indian J Otolaryngol Head Neck Surg

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The objective of this study is to correlate tumour volume relationship with surgical outcomes in subtotal resections and accepted nomenclature through a retrospective study at Charing Cross Hospital, London, a tertiary referral centre. The participants were 16 patients with vestibular schwannoma managed with subtotal resection between 2002 and 2011. The main outcome measures were surgical technique; tumour volume; recurrence and post-operative facial nerve function. Mean preoperative and post-operative volumes for all patients were 14.7 and 3.7 cm 3 respectively. Tumour volumes do not correlate with diameter (p \ 0.05). Mean reduction in volume of these subtotal resections was 75 %. Long term facial nerve outcome was good in the majority of patients: House-Brackmann Grade I/II in 12 (75 %), Grade III/IV in 2 (12.5 %) and Grade V/VI in 2 patients (12.5 %). Notably, two patients with Grade I/II House-Brackmann grading later developed Grade V/VI palsy following adjunctive radiotherapy. Seven of the 16 subtotal resections had subsequent radiotherapy or microsurgery. Mean follow up was 26.5 months. In conclusion, subtotal resections lead to good facial nerve outcomes but may require further treatments. Radiation treatment can worsen facial nerve function. There is no standardised use of tumour volumes or accepted guidelines for resection terminology. We propose the use of tumour volumes to define this further.

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Section: Introductionmentioning

confidence: 99%

“…Whilst historically the main aim was for complete tumour removal, this has now been superseded with achieving the best patient outcome-by optimising post-operative cranial nerve function whilst safeguarding for tumour re-growth [5].…”

Section: Introductionmentioning

confidence: 99%

Tumour Resection Volumes and Facial Nerve Outcomes for Vestibular Schwannomas

Virk

Tripathi

Randhawa

et al. 2014

Indian J Otolaryngol Head Neck Surg

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“…However, microsurgery cannot achieve the facial and cochlear nerve outcomes of radiosurgery. 78,95 Because functional deficits of the facial nerve lead to physical, cosmetic, and psychological consequences for patients, avoidance of facial nerve palsy is a major goal of VS surgery. 3,31,59 Therefore, it is critical to compare the pre-and postoperative facial nerve function in patients with VS, not only for effective care of these patients, but also to assess the likelihood of functional recovery.…”

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confidence: 99%

“…95 Moreover, these tumors are generally slow growing, and other adjunctive therapies such as Gamma Knife surgery are available for the residual tumors. In a comparison of 15 patients who underwent subtotal resection of tumors that exceeded 3 cm in diameter with the published results of patients with similarly larger tumors, Raftopoulos et al 74 found that facial nerve dysfunction was 0% in their patients compared with 20%-35% in patients from other published series.…”

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confidence: 99%

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Neuroanatomical correlation of the House-Brackmann grading system in the microsurgical treatment of vestibular schwannoma

Sun

Oh²,

Safaee³

et al. 2012

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Avoidance of facial nerve injury is one of the major goals of vestibular schwannoma (VS) surgery because functional deficits of the facial nerve can lead to physical, cosmetic, and psychological consequences for patients. Clinically, facial nerve function is assessed using the House-Brackmann grading scale, which also allows physicians to track the progress of a patient's facial nerve recovery. Because the facial nerve is a peripheral nerve, it has the ability to regenerate, and the extent of its functional recovery depends largely on the location and nature of its injury. In this report, the authors first describe the facial nerve anatomy, the House-Brackmann grading system, and factors known to be predictors of postoperative facial nerve outcome. The mechanisms and pathophysiology of facial nerve injury during VS surgery are then discussed, as well as factors affecting facial nerve regeneration after surgery.

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