title: Cystic versus solid vestibular schwannomas: a series of 80 grade III-IV patients.
abstract: Cystic acoustic neuromas are less frequent than solid ones and present different clinical and radiological features. Cystic schwannomas are larger, show a shorter clinical history and a different risk of postoperative complications. This study was designed to compare surgical results and complications of solid and cystic vestibular schwannomas of matching size operated upon via either a retrosygmoid or a translabyrinthine approach. The study included 80 patients presenting with grade III and IV acoustic vestibular schwannomas referred to the Neurosurgical and ENT team in the Department of Neuroscience of Torino, Italy. Twenty-six were cystic and 54 were solid tumours. Clinical history, surgical results and complications were compared between the two groups. In cystic tumors, rapid clinical worsening is common, due to sudden expansion of cystic elements. Tighter adherences are found between cystic tumours and nervous elements (particularly brainstem and possibly facial nerve), once compared to solid ones. Operative morbidity appears to be higher in cystic tumours. A wait and see policy should not to be applied to patients with cystic tumours. Careful technique, possibly sharp dissection, to divide the tumour adherences from the nervous tissue must be employed, in order to avoid lesions on brainstem veins and traction on a thin facial nerve. Severe complications may be caused by the excessive efforts to dissect brainstem adherences.
authors.affiliation: Department of Neuroscience, Neurosurgery Section, University of Torino, Ospedale S. Giovanni, Via Cherasco, 15, 10126 Torino, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Benech
authors.forename: Rosa
authors.initials: R
authors.lastname: Perez
authors.forename: Marco Maria
authors.initials: MM
authors.lastname: Fontanella
authors.forename: Bruno
authors.initials: B
authors.lastname: Morra
authors.forename: Roberto
authors.initials: R
authors.lastname: Albera
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ducati
mesh_terms: D000172:Acromegaly / Q000209:etiology* / Q000628:therapy*; D000236:Adenoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D003238:Connective Tissue / Q000473:pathology / Q000601:surgery; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D010907:Pituitary Hormones / Q000172:deficiency; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*
chemical_list: D010907:Pituitary Hormones; D019382:Human Growth Hormone
references.citation: AJNR Am J Neuroradiol. 1993 Sep-Oct;14(5):1241-7
references.pmid: 8237710
references.citation: J Clin Neurosci. 2002 Jul;9(4):453-5
references.pmid: 12217679
references.citation: Acta Neurochir (Wien). 1991;110(3-4):120-3
references.pmid: 1927602
references.citation: Neurosurgery. 1997 Mar;40(3):469-81; discussion 481-2
references.pmid: 9055285
references.citation: Virchows Arch A Pathol Anat Histopathol. 1992;420(1):59-64
references.pmid: 1539452
references.citation: Stereotact Funct Neurosurg. 1996;66 Suppl 1:103-11
references.pmid: 9032850
references.citation: J Formos Med Assoc. 1995 Aug;94(8):487-93
references.pmid: 7549578
references.citation: Acta Neurochir (Wien). 1999;141(12):1281-5; discussion 1285-6
references.pmid: 10672298
references.citation: J Laryngol Otol. 2000 Dec;114(12):935-9
references.pmid: 11177361
references.citation: Arch Otolaryngol Head Neck Surg. 1994 Dec;120(12):1333-8
references.pmid: 7980897
references.citation: Acta Otolaryngol Suppl. 1997;530:1-27
references.pmid: 9288227
references.citation: Neurosurgery. 1997 Jan;40(1):11-21; discussion 21-3
references.pmid: 8971819
references.citation: Can Assoc Radiol J. 1993 Dec;44(6):453-9
references.pmid: 8252428
references.citation: Acta Neurochir (Wien). 1996;138(6):695-9
references.pmid: 8836284
references.citation: Laryngoscope. 1994 Nov;104(11 Pt 1):1348-52
references.pmid: 7968163
references.citation: Otolaryngol Head Neck Surg. 1985 Apr;93(2):146-7
references.pmid: 3921901
references.citation: J Laryngol Otol. 1994 May;108(5):375-9
references.pmid: 8035113
references.citation: Neuroradiology. 1986;28(3):208-14
references.pmid: 3725009
references.citation: Acta Otolaryngol. 1993 Jul;113(4):519-23
references.pmid: 8379308