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Treatment of residual vestibular schwannoma
Mario Sanna1, Maurizio Falcioni, Abdelkader Taibah
1Gruppo Otologico, Piacenzo-Roma, Italy. mario.sanna@gruppootologico.it
Objective:
To evaluate the results of the surgical removal of residual vestibular schwannomas and compare them with results obtained from the first operation.
Study Design:
Retrospective case review.
Setting:
Tertiary otologic and skull base referral center. PATIENTS Twenty-three patients with residual vestibular schwannoma from a total of 637 patients who underwent surgery during the same time (April 1987 to April 2001). Only 1 patient had previously been treated in the same center. All but 1 patient had previously undergone at least 1 retrosigmoid approach. The majority of patients experienced an extensive list of complications and additional treatments after the first operation. Only 2 patients experienced some measurable hearing preoperatively. Previous hospitalization averaged 34.9 days, with a minimum of 5 and a maximum of 150 days.
Interventions:
16 patients were treated through an enlarged translabyrinthine approach and 7 through a modified transcochlear approach.
Main Outcome Measures:
Total tumor removal, postoperative complications, hospital stay.
Results:
All but 2 patients underwent a total removal. Complications recorded were 1 temporary hemiparesis and aphasia, 1 subcutaneous abdominal hematoma, and 2 transitory VIth cranial nerve palsies. No additional treatment was required. The postoperative hospital stays ranged from 3 to 22 days, with a mean of 6.9.
Conclusions:
Patients with vestibular schwannoma should be treated by an experienced team in a referral center to reduce postoperative morbidity and decrease the need to resort to only partial removal. Planned subtotal removal should be reserved for a few selected cases. The retrosigmoid approach is considered to have the highest risk that tumor remnants will unintentionally be left. In surgery of a residual vestibular schwannoma that has previously been treated through the retrosigmoid approach, the translabyrinthine approach offers some advantages with respect to performing another retrosigmoid procedure. In the presence of long-lasting facial palsy, the modified transcochlear approach represents the safest and most viable option available.