Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and restrosigmoid approaches

Noudel, R.; Gomis, Philippe; Duntze, J.; Marnet, D.; Bazin, Arnaud; Roche, Pièrre-Hugues

doi:10.1007/s00701-009-0344-z

Cited by 46 publications

(27 citation statements)

References 74 publications

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“…59,81 The higher incidence of facial nerve dysfunction for all patients with tumors larger than 3.0 cm is likely related to the effect of tumor size. 17,26,42,65,66,77 In summary, our analysis demonstrates the clear benefit of the retrosigmoid approach specifically for facial function among patients with tumors that are intracanalicular and 1.5-3.0 cm in size, with no difference in benefit between the middle cranial fossa and retrosigmoid approaches for patients with extrameatal tumor diameters less than 1.5 cm. For most tumor sizes, the translabyrinthine approach seems to be associated with a higher rate of facial nerve dysfunction.…”

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confidence: 60%

“…Data for facial nerve dysfunction and hearing loss were stratified based on tumor size because tumor size has been shown to be the most important predictive factor for outcome related to these variables. 17,26,42,65,66,77 Tumors were stratified as entirely IC (no extrameatal extension) or based on their extrameatal diameter (< 1.5 cm, 1.5-3.0 cm, or > 3.0 cm into the CPA). Table 1 summarizes the results for different clinical variables based on surgical approach.…”

Section: Reviewmentioning

confidence: 99%

“…Many physicians choose the conservative approach if patients have small tumors, 18 minimal or no symptoms, poor overall health status, or if they are elderly, 24,33,87 but this approach may still result in hearing loss over time. 35,41,65,70,91 Radiosurgery is often chosen for patients with tumors smaller than 2.5 cm or for the elderly. Patients harboring recurrent or residual tumors are also frequently referred for radiosurgery rather than an additional operation.…”

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confidence: 99%

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Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

260

216

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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confidence: 60%

Section: Reviewmentioning

confidence: 99%

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confidence: 99%

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Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

260

216

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“…Class II or higher evidence for intracanalicular VS managed through microsurgery is lacking. Recently, Noudel et al 70 conducted a systematic review that included 35 studies of microsurgical resection of intracanalicular VS. They reported that the average hearing preservation rate (AAO-HNS Classes A and B or GRC I and II) for intracanalicular VS was 58% with a retrosigmoid approach and 62% with a middle fossa approach.…”

Section: Facial Nerve Outcomes After Microsurgerymentioning

confidence: 99%

An update on unilateral sporadic small vestibular schwannoma

Thakur¹,

Banerjee

Khan³

et al. 2012

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Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.

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“…The middle fossa approach and the retrosigmoid approach offer similar hearing preservation. 14) The advantage of the retrosigmoid approach is comfortable exposure of the tumor and adjacent dura, and good control of the neurovascular structure. 5) The relationship between the facial or cochlear nerve and the tumor is predictable for VSs, but the nerve bundle has a more variable relationship with meningiomas.…”

Section: Iac Meningioma With Rapidly Progressive Hearing Lossmentioning

confidence: 99%

Meningioma of the Internal Auditory Canal With Rapidly Progressive Hearing Loss -Case Report-

Ishikawa

Kawamata

Kawashima

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 38-year-old male presented with a meningioma within the internal auditory canal (IAC) manifesting as rapidly progressive hearing loss over a period of one month. He had a 2-year history of tinnitus. Magnetic resonance imaging revealed a 10-mm intracanalicular tumor, which was surgically resected by a retrosigmoid lateral suboccipital approach. The histological findings showed meningothelial meningioma. The patient had no facial palsy after surgery, but his cochlear function did not recover. Common symptoms of IAC meningiomas are tinnitus and hearing loss, but rapidly progressive hearing loss is very rare. IAC meningioma is rare but should be taken into consideration as a cause of rapidly progressive hearing loss.

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Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and restrosigmoid approaches

Cited by 46 publications

References 74 publications

Surgery for vestibular schwannomas: a systematic review of complications by approach

Surgery for vestibular schwannomas: a systematic review of complications by approach

An update on unilateral sporadic small vestibular schwannoma

Meningioma of the Internal Auditory Canal With Rapidly Progressive Hearing Loss -Case Report-

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