The Outcome of the Retrosigmoid approach in the Vestibular Schwannomas decompression, A Retrospective Cohort Study of 60 consecutive cases

Abstract

Introduction Vestibular schwannomas are common tumors of the vestibulocochlear nerve, accounting for 75–90% of cerebellopontine angle masses. They typically present as adult-onset hearing loss or tinnitus and can also cause mass effect symptoms. They are usually benign and arise from the vestibular nerve. The aim of this study to revisit again the outcome of the surgical removal of this tumor when it was performed by retro sigmoid approachMaterial and Methods A retrospective cohort study was conducted on 60 patients with vestibular nerve sheath tumors who underwent surgery between 2016 and 2019. The study evaluated age, gender, symptoms, tumor size, surgery period, complications, and mortality. Facial and auditory functions were assessed using approved criteria. MRI was done before and after surgery, and during follow-up. The study followed up with patients for 6 months to 3 years and compared results with international studies.Results In our study, we found that 80% of patients experienced hearing loss, with the majority of cases being progressive. The size of the tumor was found to be the most important prognostic factor for predicting the audiological outcome of surgery. Additionally, facial weakness was evident in 10% of patients preoperatively, and after surgery, 10% of patients had poor to no function of the facial nerve. This was not linked to tumor size but rather to the extent of resection. Tinnitus was found to occur more frequently in patients with larger tumors, while headaches were more common in patients with larger tumors both before and after surgery. Patients generally showed an improvement in balance disorder after surgery, with greater benefit observed in those with larger tumors. In terms of functional recovery, 41.67% of patients regained their previous activity in less than 4 months, while 25% regained their activity between 4–12 months, and 33.33% did not regain their previous activity before surgery. Finally, we observed a low mortality rate of 0.6% in our study, with two out of 60 patients passing away after surgery.Conclusion In summary, a retrospective analysis of 60 vestibular schwannoma cases treated by retrosigmoidal surgery revealed potential complications such as a decline in facial nerve function, tinnitus in larger tumors, and headaches both before and after surgery. However, there was an improvement in balance disorder post-surgery, and the mortality rate was low at 0.06%. In addition, a significant portion of patients were able to regain their professional activity after surgery. These findings highlight the importance of careful consideration of the risks and benefits of this surgery when deciding on the best treatment approach for vestibular schwannoma.