Treatment of residual vestibular schwannoma.
OBJECTIVE
To evaluate the results of the surgical removal of residual vestibular schwannomas and compare them with results obtained from the first operation.


METHODS
Retrospective case review.


METHODS
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.


METHODS
16 patients were treated through an enlarged translabyrinthine approach and 7 through a modified transcochlear approach.


METHODS
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.
Sanna
Mario
M
Gruppo Otologico, Piacenzo-Roma, Italy. mario.sanna@gruppootologico.it
Falcioni
Maurizio
M
Taibah
Abdelkader
A
De Donato
Guiseppe
G
Russo
Alessandra
A
Piccirillo
Enrico
E
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000601:surgery*; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000601:surgery*; D010348:Patient Care Team; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012017:Referral and Consultation; D012086:Reoperation; D012189:Retrospective Studies