Translabyrinthine approach for the management of large and giant vestibular schwannomas.
BACKGROUND
The removal of large vestibular schwannomas through the translabyrinthine approach is still controversial.


METHODS
A retrospective review was performed of 81 patients (58 men and 23 women) with vestibular schwannomas 3 cm or greater, who underwent tumor removal via the translabyrinthine approach between 1985 and 2000. The mean tumor size was 3.7 +/- 0.81 cm, and the mean age of the patients was 47 +/- 16.1 years. The largest tumor was 6 cm. All surgical procedures were performed in collaboration with a neurosurgery team.


RESULTS
Total tumor removal was accomplished in 77 cases (95.1%). The facial nerve was preserved anatomically in 69 (85.2%) of the patients. In 4 patients, divided nerves were repaired by primary anastomosis. Facial nerve function was assessed immediately after surgery and 1 year or more after discharge. Good function (House-Brackmann facial nerve Grade I or II) was present in 45% of patients and acceptable function (Grades I-IV) in 80% of patients 1 year after resection of the tumor. Cerebrospinal fluid leakage occurred in 12 patients (17%), meningitis developed in 3 patients (4%), and 1 patient experienced a stroke immediately after surgery. There were no deaths caused by surgery in this series.


CONCLUSIONS
The translabyrinthine approach offers an excellent anatomical view of the cerebellopontine angle and a direct approach to the tumor with functional preservation of the facial nerve. Total removal is accomplished in most cases, with minimum incidence of morbidity and no incidence of mortality.
Mamikoglu
Bulent
B
Division of Otolaryngology, Northwestern University Medical School, Evanston Hospital, Evanston Northwestern Health Care System, Evanston, Illinois 60201, USA.
Wiet
Richard J
RJ
Esquivel
Carlos R
CR
D000714:Anastomosis, Surgical; D002558:Cerebrospinal Fluid Otorrhea / Q000453:epidemiology / Q000209:etiology; D007758:Ear, Inner; D005154:Facial Nerve / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000209:etiology; D006801:Humans; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology