title: Translabyrinthine approach for vestibular schwannomas: operative technique.
abstract: For large vestibular schwannomas (VSs) for which removal is the primary therapy, the goals are complete tumor resection and maintenance of normal neurological function. The authors analyzed their results about facial nerve preservation, extent of resection and complications following resection of large VSs via a widened translabyrinthine approach. Between 1991 and 2001, 110 patients with a unilateral large VS (Koos stage IV) were operated on using the same technique in the same institution. The main steps of the operative technique were detailed and the clinical outcomes analyzed and compared with the results that were extracted from matched series in the literature. The main postoperative complications were cerebrospinal fluid leakage through the scalp wound in 4%, cerebrospinal fluid rhinorrhea in 4% requiring surgical revision in 3%. One percent of meningitis, 1% of posterior fossa hematoma and 4% of transient lower cranial nerve palsies were observed. There was no death related to the surgery. Total tumor removal was achieved in 85% of cases, near-total in 11% and subtotal in 4% of cases. Sixty-two percent of patients obtained normal to near-normal facial function (House-Brackmann grades 1 and 2). The authors suggest that the translabyrinthine approach is a suitable route for the safe removal of large VSs.
authors.affiliation: Service de Neurochirurgie, Hôpital Sainte-Marguerite, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Roche
authors.forename: William
authors.initials: W
authors.lastname: Pellet
authors.forename: Takuzo
authors.initials: T
authors.lastname: Moriyama
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Thomassin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D007758:Ear, Inner / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult