Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients.
OBJECTIVE
The aim of this study was to evaluate and present the results of current surgical treatment of vestibular schwannomas (VSs) and to report the refinements in the operative technique.


METHODS
The authors performed a retrospective study of 200 consecutive patients who had undergone VS surgery over a 3-year period. Patient records, operative reports, follow-up data, and neuroradiological findings were analyzed. The main outcome measures were magnetic resonance imaging, neurological status, patient complaints, and surgical complications. Complete tumor removal was achieved in 98% of patients. Anatomical preservation of the facial nerve was possible in 98.5% of patients. In patients treated for tumors with extension Classes T1, T2, and T3, the rate of facial nerve preservation was 100%. By the last follow-up examination, excellent or good facial nerve function had been achieved in 81% of the cases. By at least 1 year postsurgery, no patients had total facial palsy. In the patients with preserved hearing, the rate of anatomical preservation of the cochlear nerve was 84%. The overall rate of functional hearing preservation was 51%. There was no surgery-related permanent morbidity in this series of patients. Cerebrospinal fluid leakage was diagnosed in 2% of the patients. The mortality rate was 0%.


CONCLUSIONS
The goal of VS treatment should be total removal in one stage and preservation of neurological function, as they determine a patient's quality of life. This goal can be safely and successfully achieved using the retrosigmoid approach.
Samii
Madjid
M
Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany.
Gerganov
Venelin
V
Samii
Amir
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002530:Cerebellopontine Angle / Q000601:surgery; D003056:Cochlear Nerve / Q000503:physiopathology; D004576:Electromyography; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005152:Facial Muscles / Q000294:innervation; D005154:Facial Nerve / Q000503:physiopathology; D005158:Facial Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009460:Neurologic Examination; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D012189:Retrospective Studies