Download PDF
J Neurol Surg B Skull Base 2012; 73(03): 168-174
DOI: 10.1055/s-0032-1301403
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcome after Translabyrinthine Surgery for Vestibular Schwannomas: Report on 1244 Patients

Jacob Bertram Springborg
1   University Clinic of Neurosurgery, Copenhagen University Hospital, Copenhagen Ø, Denmark
,
Kåre Fugleholm
1   University Clinic of Neurosurgery, Copenhagen University Hospital, Copenhagen Ø, Denmark
,
Lars Poulsgaard
1   University Clinic of Neurosurgery, Copenhagen University Hospital, Copenhagen Ø, Denmark
,
Per Cayé-Thomasen
2   Department of Oto-rhino-laryngology, Head and Neck Surgery, Gentofte University Hospital, Hellerup, Denmark
,
Jens Thomsen
2   Department of Oto-rhino-laryngology, Head and Neck Surgery, Gentofte University Hospital, Hellerup, Denmark
,
Sven-Eric Stangerup
2   Department of Oto-rhino-laryngology, Head and Neck Surgery, Gentofte University Hospital, Hellerup, Denmark
› Author Affiliations
Further Information

Publication History

04 November 2011

13 November 2011

Publication Date:
22 February 2012 (online)

    Permissions and Reprints

Abstract

The objective of this article is to study the outcome after translabyrinthine surgery for vestibular schwannomas, with special focus on the facial nerve function. The study design is a case series from a national centralized database and it is set in two University Hospitals in Denmark. Participants were 1244 patients who underwent translabyrinthine surgery during a period of 33 years from 1976 to 2009. Main outcome measures were tumor removal, intraoperative facial nerve preservation, complications, and postoperative facial nerve function. In 84% patients, the tumor was totally resected and in ~85% the nerve was intact during surgery. During 33 years, 12 patients died from complications to surgery and ~14% had cerebrospinal fluid leakage. Before surgery, 74 patients had facial paresis and 46% of these improved after surgery. In patients with normal facial function, overall ~70% had a good outcome (House-Brackmann grade 1 or 2). The chance of a good outcome was related to tumor size with a higher the chance the smaller the tumor, but not to the degree of tumor removal. In ~78% of the patients with facial paresis at discharge the paresis improved over time, in ~42% from a poor to a good function. The translabyrinthine approach is generally efficient in tumor control and with satisfactory facial nerve outcome. With larger tumors the risk of a poor outcome is evident and more data on patients managed with alternative strategies are warranted.

Keywords

vestibular schwannoma - translabyrinthine surgery - outcome - facial nerve
 

  • References

  • 1 Thomsen J, Tos M, Møller H, Charabi S. The choice of approach in surgery for acoustic neuromas (vestibular schwannomas). Tokai J Exp Clin Med 1994; 19 (3-6) 93-101
    PubMedGoogle Scholar
  • 2 Stangerup S-E, Tos M, Thomsen J, Caye-Thomasen P. Hearing outcomes of vestibular schwannoma patients managed with ‘wait and scan’: predictive value of hearing level at diagnosis. J Laryngol Otol 2010; 124 (5) 490-494
    CrossrefPubMedGoogle Scholar
  • 3 Pollock BE, Driscoll CLW, Foote RL , et al. Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 2006; 59 (1) 77-85 , discussion 77–85
    CrossrefPubMedGoogle Scholar
  • 4 Myrseth E, Møller P, Pedersen P-H, Lund-Johansen M. Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 2009; 64 (4) 654-661, discussion 661–663
    CrossrefPubMedGoogle Scholar
  • 5 Tos M, Thomsen J. The translabyrinthine approach for the removal of large acoustic neuromas. Arch Otorhinolaryngol 1989; 246 (5) 292-296
    CrossrefPubMedGoogle Scholar
  • 6 Brackmann DE, Cullen RD, Fisher LM. Facial nerve function after translabyrinthine vestibular schwannoma surgery. Otolaryngol Head Neck Surg 2007; 136 (5) 773-777
    CrossrefPubMedGoogle Scholar
  • 7 Tos M, Charabi S, Thomsen J. Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results. Eur Arch Otorhinolaryngol 1998; 255 (1) 1-6
    CrossrefPubMedGoogle Scholar
  • 8 Stangerup S-E, Tos M, Caye-Thomasen P, Tos T, Klokker M, Thomsen J. Increasing annual incidence of vestibular schwannoma and age at diagnosis. J Laryngol Otol 2004; 118 (8) 622-627
    PubMedGoogle Scholar
  • 9 Slattery III WH, Francis S, House KC. Perioperative morbidity of acoustic neuroma surgery. Otol Neurotol 2001; 22 (6) 895-902
    CrossrefPubMedGoogle Scholar
  • 10 Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004; 25 (3) 387-393
    CrossrefPubMedGoogle Scholar
  • 11 Brackmann DE, Green Jr JD. Translabyrinthine approach for acoustic tumor removal. 1992. Neurosurg Clin N Am 2008; 19 (2) 251-264, vi
    CrossrefPubMedGoogle Scholar
  • 12 Merkus P, Taibah A, Sequino G, Sanna M. Less than 1% cerebrospinal fluid leakage in 1,803 translabyrinthine vestibular schwannoma surgery cases. Otol Neurotol 2010; 31 (2) 276-283
    CrossrefPubMedGoogle Scholar
  • 13 Stangerup S-E, Caye-Thomasen P, Tos M, Thomsen J. Change in hearing during ‘wait and scan’ management of patients with vestibular schwannoma. J Laryngol Otol 2008; 122 (7) 673-681
    PubMedGoogle Scholar
  • 14 Kanzaki J, Tos M, Sanna M, Moffat DA, Monsell EM, Berliner KI. New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003; 24 (4) 642-648, discussion 648–649
    CrossrefPubMedGoogle Scholar
  • 15 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (2) 146-147
    Google Scholar
  • 16 Lanman TH, Brackmann DE, Hitselberger WE, Subin B. Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. J Neurosurg 1999; 90 (4) 617-623
    CrossrefPubMedGoogle Scholar
  • 17 Fayad JN, Schwartz MS, Slattery WH, Brackmann DE. Prevention and treatment of cerebrospinal fluid leak after translabyrinthine acoustic tumor removal. Otol Neurotol 2007; 28 (3) 387-390
    CrossrefPubMedGoogle Scholar
  • 18 Bouetel V, Lescanne E, François P, Jan M, Morinière S, Robier A. [Evolution of facial nerve prognosis in vestibular schwannoma surgery by translabyrinthine approach]. Rev Laryngol Otol Rhinol (Bord) 2008; 129 (1) 27-33
    PubMedGoogle Scholar
  • 19 Mass SC, Wiet RJ, Dinces E. Complications of the translabyrinthine approach for the removal of acoustic neuromas. Arch Otolaryngol Head Neck Surg 1999; 125 (7) 801-804
    PubMedGoogle Scholar
  • 20 Shamji MF, Schramm DR, Benoit BG. Clinical predictors of facial nerve outcome after translabyrinthine resection of acoustic neuromas. Clin Invest Med 2007; 30 (6) E233-E239
    PubMedGoogle Scholar
  • 21 Stangerup S-E, Thomsen J, Tos M, Cayé-Thomasen P. Long-term hearing preservation in vestibular schwannoma. Otol Neurotol 2010; 31 (2) 271-275
    CrossrefPubMedGoogle Scholar
  • 22 Roche P-H, Pellet W, Moriyama T, Thomassin J-M. Translabyrinthine approach for vestibular schwannomas: operative technique. Prog Neurol Surg 2008; 21: 73-78
    PubMedGoogle Scholar
  • 23 El-Kashlan HK, Zeitoun H, Arts HA, Hoff JT, Telian SA. Recurrence of acoustic neuroma after incomplete resection. Am J Otol 2000; 21 (3) 389-392
    PubMedGoogle Scholar
  • 24 Bloch DC, Oghalai JS, Jackler RK, Osofsky M, Pitts LH. The fate of the tumor remnant after less-than-complete acoustic neuroma resection. Otolaryngol Head Neck Surg 2004; 130 (1) 104-112
    CrossrefPubMedGoogle Scholar
  • 25 Godefroy WP, van der Mey AGL, de Bruine FT, Hoekstra ER, Malessy MJA. Surgery for large vestibular schwannoma: residual tumor and outcome. Otol Neurotol 2009; 30 (5) 629-634
    CrossrefPubMedGoogle Scholar
  • 26 Talfer S, Dutertre G, Conessa C, Desgeorges M, Poncet J-L. Surgical treatment of large vestibular schwannomas (stages III and IV). Eur Ann Otorhinolaryngol Head Neck Dis 2010; 127 (2) 63-69
    CrossrefPubMedGoogle Scholar
  • 27 Roche P-H, Ribeiro T, Khalil M, Soumare O, Thomassin JM, Pellet W. Recurrence of vestibular schwannomas after surgery. Prog Neurol Surg 2008; 21: 89-92
    PubMedGoogle Scholar
  • 28 Arriaga MA, Brackmann DE. Facial nerve repair techniques in cerebellopontine angle tumor surgery. Am J Otol 1992; 13 (4) 356-359
    PubMedGoogle Scholar
  • 29 Mamikoglu B, Wiet RJ, Esquivel CR. Translabyrinthine approach for the management of large and giant vestibular schwannomas. Otol Neurotol 2002; 23 (2) 224-227
    CrossrefPubMedGoogle Scholar
  • 30 Devèze A, Roche P-H, Facon F, Gabert K, Pellet W, Thomassin JM. [Functional outcomes after translabyrinthine approach for vestibular schwannomas]. Neurochirurgie 2004; 50 (2-3 Pt 2) 244-252
    PubMedGoogle Scholar
  • 31 Sughrue ME, Yang I, Rutkowski MJ, Aranda D, Parsa AT. Preservation of facial nerve function after resection of vestibular schwannoma. Br J Neurosurg 2010; 24 (6) 666-671
    CrossrefPubMedGoogle Scholar
  • 32 Patni AH, Kartush JM. Staged resection of large acoustic neuromas. Otolaryngol Head Neck Surg 2005; 132 (1) 11-19
    CrossrefPubMedGoogle Scholar
  • 33 Fuentes S, Arkha Y, Pech-Gourg G, Grisoli F, Dufour H, Régis J. Management of large vestibular schwannomas by combined surgical resection and gamma knife radiosurgery. Prog Neurol Surg 2008; 21: 79-82
    PubMedGoogle Scholar
  • 34 Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas. Surg Neurol 2003; 59 (4) 283-289, discussion 289–291
    PubMedGoogle Scholar
  • 35 Sakaki S, Nakagawa K, Hatakeyama T, Murakami Y, Ohue S, Matsuoka K. Recurrence after incompletely resected acousticus neurinomas. Med J Osaka Univ 1991; 40 (1-4) 59-66
    PubMedGoogle Scholar
  • 36 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve—preservation and restitution of function. Neurosurgery 1997; 40 (4) 684-694, discussion 694–695
    CrossrefPubMedGoogle Scholar
  • 37 Tos T, Caye-Thomasen P, Stangerup S-E, Thomsen J, Tos M. Need for facial reanimation after operations for vestibular schwannoma: patients perspective. Scand J Plast Reconstr Surg Hand Surg 2003; 37 (2) 75-80
    CrossrefPubMedGoogle Scholar
  • 38 Darrouzet V, Martel J, Enée V, Bébéar J-P, Guérin J. Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope 2004; 114 (4) 681-688
    CrossrefPubMedGoogle Scholar
  • 39 Nguyen DQ, Franco-Vidal V, Guérin J, Darrouzet V. [Delayed facial palsy after vestibular schwannoma resection: the role of viral reactivation. Our experience in 8 cases]. Rev Laryngol Otol Rhinol (Bord) 2004; 125 (1) 23-29
    PubMedGoogle Scholar
  • 40 Magliulo G, D’Amico R, Di Cello P. Delayed facial palsy after vestibular schwannoma resection: clinical data and prognosis. J Otolaryngol 2003; 32 (6) 400-404
    CrossrefPubMedGoogle Scholar