Download PDF
Skull Base 2002; 12(4): 189-196
DOI: 10.1055/s-2002-35750
ORIGINAL ARTICLE

Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Current Results of the Surgical Management of Acoustic Neuroma

Sun H. Lee1 , Thomas O. Willcox2  Jr. , William A. Buchheit3
  • 1Division of Neurosurgery, UMDNJ-Robert Wood Johnson University Hospital, New Brunswick, New Jersey
  • 2Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
  • 3Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
14 May 2004 (online)

    Permissions and Reprints

ABSTRACT

A retrospective analysis of 162 consecutive cases in 160 patients who underwent microsurgical resection of vestibular schwannomas between October 1995 and June 2001 was undertaken to compare the results with those of other treatment modalities. Patient hospital records, operative video pictures, neuroimaging studies, audiograms, and follow-up data were reviewed. The mean follow-up period was 24 months.

There were 34 small (<1.5 cm), 92 medium (1.5-3 cm), and 36 (>3 cm) large tumors. Six were recurrent tumors. Gross total resection was accomplished in all 34 small tumors and 92 medium tumors but only in 50% of the large tumors. Among the 126 small and medium tumors, the facial nerve was saved anatomically in 124 patients. On long-term follow up, facial function was preserved in 94.4% of all patients. Anatomically, the cochlear nerve was preserved in 55.9% of the small and 20.7% of the medium tumors. Function was preserved (Gardner-Robertson class 1 and 2) in 25% of the small and in 19.4% of the medium tumors. Cerebrospinal leakage was present in 10.5%, meningitis in 9.9%, wound infection in 3.7%, and hematoma or contusion in 2.5%. Only one patient died (mortality rate 0.6%). Our data reflect that surgical removal should be the standard management for acoustic tumors, particularly for large and medium tumors, and can be accomplished with acceptable complication rates.

KEYWORDS

Acoustic neuroma - complications - surgical outcome

REFERENCES

  • 1 Ojemann R G. Management of acoustic neuromas (vestibular schwannomas).  Clin Neurosurg. 1993;  40 498-535
    PubMedGoogle Scholar
  • 2 Samii M, Matthies C, Tatagiba M. Intracanalicular acoustic neurinomas.  Neurosurgery . 1991;  29 189-199
    PubMedGoogle Scholar
  • 3 Acoustic Neuroma. In: NIH Consensus Development Conference Consensus Statement vol 9 National Institutes of Health, Bethesda, MD 1991: 1-24
    Google Scholar
  • 4 Wiegand D A, Ojemann R G, Fickel V. Surgical treatment of acoustic neuroma (vestibular schwannoma) in the United States: Report from the acoustic neuroma registry.  Laryngoscope . 1996;  106 58-66
    PubMedGoogle Scholar
  • 5 Bederson J B, Von Ammon K, Wichmann W W, Yasargil M G. Conservative treatment of patients with acoustic tumors.  Neurosurgery . 1991;  28 646-651
    CrossrefPubMedGoogle Scholar
  • 6 Charabi S, Thomsen J, Mantoni M. Acoustic neuroma (vestibular schwannoma): Growth and surgical and nonsurgical consequences of the wait-and see policy.  Otolaryngol Head Neck Surg . 1995;  113 5-14
    PubMedGoogle Scholar
  • 7 Deen H G, Ebersold M J, Harner S G. Conservative management of acoustic neuroma: An outcome study.  Neurosurgery . 1996;  39 260-266
    CrossrefPubMedGoogle Scholar
  • 8 Kanzaki J, Ogawa K, Ogawa S, Yamamoto M, Ikeda S, O-Uchi T. Audiological findings in acoustic neuroma.  Acta Otolaryngol . 1991;  487 125-132
    PubMedGoogle Scholar
  • 9 Saunders J E, Luxford W M, Devgan K K, Fetterman B L. Sudden hearing loss in acoustic neuroma patients.  Otolaryngol Head Neck Surg . 1995;  113 23-31
    CrossrefPubMedGoogle Scholar
  • 10 Yanagihara N, Asai M. Sudden hearing loss induced by acoustic neuroma: Significance of small tumors.  Laryngoscope . 1993;  103 308-311
    PubMedGoogle Scholar
  • 11 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg . 1985;  93 146-147
    Google Scholar
  • 12 Nutik S L. Facial nerve outcome after acoustic neuroma surgery.  Surg Neurol . 1994;  41 28-33
    PubMedGoogle Scholar
  • 13 Lalwani A K, Butt F Y, Jackler R K, Pitts L H, Yingling C D. Facial nerve outcome after acoustic neuroma surgery: A study from the era of cranial nerve monitoring.  Otolaryngol Head Neck Surg . 1994;  111 561-570
    CrossrefPubMedGoogle Scholar
  • 14 Brackmann D R, Hitselberger W E, Beneke J E, House W F. Acoustic neuromas. Middle fossa and translabyrinthine removal in Rand RW(ed): Microneurosurgery St. Louis, MO: C.V. Mosby Co. 1985: 311-334
    Google Scholar
  • 15 Haines S J, Levine S C. Intracanalicular acoustic neuroma: early surgery for preservation of hearing.  J Neurosurg . 1993;  79 515-520
    Google Scholar
  • 16 Hardy D G, Macfarlane R, Baguley D, Moffat D A. Surgery for acoustic neuroma. An analysis of 100 trans-labyrinthine operations.  J Neurosurg . 1989;  71 799-804
    CrossrefPubMedGoogle Scholar
  • 17 Jackler R K, Pitts L H. Selection of surgical approach to acoustic neuroma.  Otolaryngol Clin North Am . 1992;  25 361-387
    PubMedGoogle Scholar
  • 18 Ebersold M J, Harner S G, Beatty C W, Harper C M, Quast L M. Current results of the retrosigmoid approach to acoustic neuroma.  J Neurosurg . 1992;  76 901-909
    CrossrefPubMedGoogle Scholar
  • 19 Pollock B E, Lunsford L D, Kondziolka D. Outcome analysis of acoustic neuroma management: A comparison of microsurgery and stereotactic radiosurgery.  Neurosurgery . 1995;  36 215-229
    CrossrefPubMedGoogle Scholar
  • 20 Sampath P, Holliday M J, Brem H, Niparko J K, Long D M. Facial nerve injury in acoustic neuroma (vestibular schwannoma) surgery: etiology and prevention.  J Neurosurg . 1997;  87 60-66
    CrossrefPubMedGoogle Scholar
  • 21 Glassock III E M, Hays J W, Minor L B, Haynes D S, Carrasco V N. Preservation of hearing in surgery for acoustic neuromas.  J Neurosurg . 1993;  78 864-870
    PubMedGoogle Scholar
  • 22 Jannetta P J, Moller A R, Moller M B. Technique of hearing preservation in small acoustic neuromas.  Ann Surg . 1984;  200 513-523
    PubMedGoogle Scholar
  • 23 Snyder W E, Pritz M B, Smith R R. Suboccipital resection of a medial acoustic neuroma with hearing preservation.  Surg Neurol . 1999;  51 548-553
    PubMedGoogle Scholar
  • 24 Schessel D A, Nedzelski J M, Kassel E E, Rowed D W. Recurrence rates of acoustic neuroma in hearing preservation surgery.  Am J Otol . 1992;  13 233-235
    PubMedGoogle Scholar
  • 25 Weit R J, Teixido M, Liang J. Complications in acoustic neuroma surgery.  Otolaryngol Clin North Am . 1992;  25 389-412
    PubMedGoogle Scholar
  • 26 Fishman A J, Hoffman R A, Roland Jr T, Lebowitz R A, Cohen N L. Cerebrospinal fluid drainage in the management of CSF leak following acoustic neuroma surgery.  Laryngoscope . 1996;  106 1002-1004
    CrossrefPubMedGoogle Scholar
  • 27 Flickinger J C, Kondziolka D, Lunsford L D. Dose and diameter relationships for facial, trigeminal and acoustic neuropathies following acoustic neuroma radiosurgery.  Radiother Oncol . 1996;  41 215-219
    CrossrefPubMedGoogle Scholar
  • 28 Niranjan A, Lunsford L D, Flickinger J C, Maitz A, Kondziolka D. Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery.  Neurosurgery . 1999;  45 753-765
    CrossrefPubMedGoogle Scholar
  • 29 Poen J C, Golby A J, Forster K M. Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: A preliminary report.  Neurosurgery . 1999;  45 1299-1307
    CrossrefPubMedGoogle Scholar
      >