Cystic versus solid vestibular schwannomas: a series of 80 grade III-IV patients.
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.
Benech
Franco
F
Department of Neuroscience, Neurosurgery Section, University of Torino, Ospedale S. Giovanni, Via Cherasco, 15, 10126 Torino, Italy.
Perez
Rosa
R
Fontanella
Marco Maria
MM
Morra
Bruno
B
Albera
Roberto
R
Ducati
Alessandro
A
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*
D010907:Pituitary Hormones; D019382:Human Growth Hormone
AJNR Am J Neuroradiol. 1993 Sep-Oct;14(5):1241-7
8237710
J Clin Neurosci. 2002 Jul;9(4):453-5
12217679
Acta Neurochir (Wien). 1991;110(3-4):120-3
1927602
Neurosurgery. 1997 Mar;40(3):469-81; discussion 481-2
9055285
Virchows Arch A Pathol Anat Histopathol. 1992;420(1):59-64
1539452
Stereotact Funct Neurosurg. 1996;66 Suppl 1:103-11
9032850
J Formos Med Assoc. 1995 Aug;94(8):487-93
7549578
Acta Neurochir (Wien). 1999;141(12):1281-5; discussion 1285-6
10672298
J Laryngol Otol. 2000 Dec;114(12):935-9
11177361
Arch Otolaryngol Head Neck Surg. 1994 Dec;120(12):1333-8
7980897
Acta Otolaryngol Suppl. 1997;530:1-27
9288227
Neurosurgery. 1997 Jan;40(1):11-21; discussion 21-3
8971819
Can Assoc Radiol J. 1993 Dec;44(6):453-9
8252428
Acta Neurochir (Wien). 1996;138(6):695-9
8836284
Laryngoscope. 1994 Nov;104(11 Pt 1):1348-52
7968163
Otolaryngol Head Neck Surg. 1985 Apr;93(2):146-7
3921901
J Laryngol Otol. 1994 May;108(5):375-9
8035113
Neuroradiology. 1986;28(3):208-14
3725009
Acta Otolaryngol. 1993 Jul;113(4):519-23
8379308