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Acoustic neuroma (schwannoma) surgery 1978-1990
J E Dutton1, R T Ramsden, R H Lye
1Department of Otolaryngology, Manchester Royal Infirmary.
Abstract:
A series of 151 patients with 154 acoustic schwannomas have been operated upon in Manchester Royal Infirmary by a joint Otological and Neurosurgical team, employing either the translabyrinthine or the suboccipital approach. The perioperative mortality rate was 3 per cent. Anatomical preservation of the facial nerve was achieved in 89 per cent of tumour removals and a good to normal functional result in 79 per cent of cases. Attempts at hearing preservation have been unsuccessful, largely because of the small number of patients in the series in whom useful hearing was present preoperatively. Complications included major brain stem ischaemia (1.2 per cent), CSF fistula (5 per cent) and facial dysaesthesia (7 per cent). The incidence of mortality and morbidity is directly related to tumour size and to the experience of the surgeons. A number of patients experienced an unusual type of post-operative dreamlike state which appeared to be a form of hypnagogic hallucination, and the possible neurophysiological mechanism responsible for this phenomenon is discussed. The continuing failure to attain the ideal of early diagnosis is lamented, and the importance of a flexible bidisciplinary surgical approach emphasized.
Insights
Surgical outcomes for acoustic schwannomas show good facial nerve preservation (89%) but limited hearing preservation. Complication rates correlate with tumor size and surgeon experience.
Area of Science:
- Neurosurgery
- Otolaryngology
- Neurology
Background:
- Acoustic schwannomas are tumors affecting the auditory-vestibular nerve.
- Surgical management requires careful consideration of neurological and auditory function.
Observation:
- 151 patients with 154 acoustic schwannomas were operated on.
- Perioperative mortality was 3%, with facial nerve preservation in 89% and good functional results in 79%.
Findings:
- Hearing preservation attempts were largely unsuccessful due to limited preoperative hearing.
- Complications included brain stem ischemia (1.2%), CSF fistula (5%), and facial dysesthesia (7%).
- Mortality and morbidity correlated with tumor size and surgeon experience.
Implications:
- A flexible, multidisciplinary surgical approach is crucial for acoustic schwannoma treatment.
- Early diagnosis of acoustic schwannomas remains a significant challenge.
- Further research into post-operative hypnagogic hallucinations is warranted.