527 fully endoscopic resections of vestibular schwannomas

We report a series of 527 patients with unilateral vestibular schwannomas (VS) who underwent fully endoscopic resection of their tumors during the period of October, 2001 to July, 2010. Patients' outcomes were evaluated, with specific regard to hearing preservation, facial nerve function, postoperative complications and completeness of the resection.

The patient population consisted of 527 cases with unilateral VS(s); patients with neurofibromatosis type 2 (NFT2) were excluded from this study. Tumors ranged in size from 0.3-5.8 cm, most tumors were less than 4 cm in diameter (mean: 2.8 cm). Tumors were removed via 2.0 cm "keyhole" retrosigmoid craniotomies.

Utilizing the fully endoscopic technique, 94% of tumors were completely removed; subtotal removal was performed in 6% of patients in an attempt to preserve their hearing. Anatomic preservation of the facial nerve was achieved in all of the patients. Functionally, measurable hearing (serviceable/some) was preserved in 57% of cases that had either "serviceable" or "some" hearing pre-operatively. There were no major neurological complications such as quadriparesis, hemiparesis, bacterial or aseptic meningitis, permanent lower cranial nerve deficits, or deaths.

From our experience, we conclude that the endoscope is ideally suited for a minimally invasive approach for resection of vestibular schwannomas.