A series of 112 fully endoscopic resections of vestibular schwannomas

We report a consecutive series of 112 patients with unilateral vestibular schwannoma (VS) having undergone fully endoscopic resection of their tumors in the period from October, 2001 to January, 2005. Patients' outcomes were evaluated especially with regards to cochlear nerve (hearing) preservation, facial nerve preservation, postoperative complications and completeness of the resection. The patient population consisted of 112 consecutive cases with unilateral, "de novo" VS(s); patients with neurofibromatosis type 2 (NFT2) or with a recurrent tumor were excluded from this study. Tumors ranged in size from 0.6-5.7 cm, most tumors were less than 3 cm in diameter (mean: 2.6 cm). This shift towards smaller and also less symptomatic tumors may be due to an increase in the awareness of patients and earlier detection of their tumors (MRI era). Tumors were removed via 1.5-cm "keyhole" retrosigmoid craniotomies. Utilizing the fully endoscopic technique, 106/112 (95%) tumors were completely removed; subtotal removal was performed in 6/112 (5%) patients in an attempt to preserve their hearing. Anatomic preservation of the facial nerve was achieved in all of the patients and of the cochlear nerve in 83/101 (82%) hearing ears. Functionally, measurable hearing (serviceable/some) was preserved in 59/101 (58%) cases who had either "serviceable" or "some" hearing preoperatively, 2 patients who had "some" hearing preoperatively had an improvement that was more than 30 db in their hearing postoperatively. There were no major neurological complications such as quadriparesis, hemiparesis, bacterial or aseptic meningitis, lower cranial nerve deficits, or deaths. From our experience, we conclude that the endoscope is ideally suited for a minimally invasive approach for the resection of vestibular schwannomas.