Microsurgery management of vestibular schwannomas in neurofibromatosis type 2: indications and results.
OBJECTIVE
To analyze the senior author's experience and strategy of treatment of patients with neurofibromatosis type 2 (NF2), with particular emphasis on vestibular schwannoma (VS) surgery.


METHODS
Over a period of more than 35 years, the senior author (M.S.) has operated on more than 165 patients with NF2. The total number of VS surgeries was 210. This retrospective analysis includes 145 consecutively operated patients. Medical records, operative reports, follow-up neurological, audiometric examinations, and neuroradiological findings were analyzed.


RESULTS
Total tumor removal was achieved in 85% of the operated tumors. In 15%, deliberately subtotal removal was performed for brain stem decompression and hearing preservation in the only hearing ear. The overall rate of hearing preservation was 35%. When only patients with preserved useful preoperative hearing were included, the rate was 65%. Bilateral hearing after surgery was preserved in 23% of the patients. The anatomical integrity of the facial nerve was preserved in 89%.


CONCLUSIONS
The goal of VS surgery in patients with NF2 should be complete removal but not at the expense of functional impairment. Carefully individualized treatment strategy offers the possibility of prolongation of life and preservation of neurological functions.
Samii
M
M
International Neuroscience Institute, Hannover, Germany.
Gerganov
V
V
Samii
A
A
D001299:Audiometry; D015331:Cohort Studies; D034381:Hearing Loss / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008866:Microsurgery; D018365:Neoplasm, Residual; D016518:Neurofibromatosis 2 / Q000473:pathology* / Q000601:surgery*; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome