Outcome from surgery for vestibular schwannomas in children.
OBJECTIVE
A review of sporadic and NF2-related vestibular schwannoma surgery in children (under 18 years of age) with a specific interest in resection rates, recurrence, facial nerve outcomes, hearing preservation, hearing rehabilitation and genetic analysis.


METHODS
A retrospective analysis of prospectively collected data of 35 consecutively operated vestibular schwannomas in 29 paediatric patients that underwent 38 operations between 1992 and 2007. Pre- and post-operative radiology, facial nerve function, pure tone audiogram and speech discrimination tests were performed with a mean follow-up of 4.5 years. Tumour and blood mutations were analysed in 86% of patients.


RESULTS
Total resection was achieved in all sporadic cases and 68% of NF2 cases. Near total resection led to tumour recurrence in 5 out of 10 cases. The facial nerve was anatomically preserved in 92%. Facial nerve function was excellent to good (Grades 1-3) in 88% with outcome related to tumour size. Hearing preservation was successful in 3 of 11 cases.


CONCLUSIONS
Surgery with complete resection results in excellent tumour control, but it is more difficult to attain total resection in NF2 with a relatively high recurrence rate of persistently growing tumours. A better facial outcome is associated with smaller tumours, near-total resection and first time surgery. Hearing preservation is possible in a minority. Hearing rehabilitation can be successful by utilising cochlear implants and auditory brain stem implants (ABI) as appropriate. Overall there is a low complication rate and results are comparable with adult series.
MacNally
Stephen P
SP
Department of Neurosurgery, Salford Royal Hospital, Manchester, UK. smacnally@hotmail.com
Rutherford
Scott A
SA
King
Andrew T
AT
Freeman
Simon
S
Thorne
John
J
Mawman
Deborah
D
O'Driscoll
Martin P
MP
Evans
D G
DG
Ramsden
Richard T
RT
D000293:Adolescent; D038262:Auditory Brain Stem Implants; D001309:Auditory Threshold / Q000502:physiology; D002648:Child; D003054:Cochlear Implants; D018389:Codon, Nonsense / Q000235:genetics; D003390:Cranial Nerve Neoplasms / Q000601:surgery; D005154:Facial Nerve / Q000502:physiology; D005155:Facial Nerve Diseases / Q000601:surgery; D005260:Female; D006311:Hearing Disorders / Q000517:prevention & control; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016518:Neurofibromatosis 2 / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D009464:Neuroma, Acoustic / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control / Q000534:rehabilitation; D011379:Prognosis; D012189:Retrospective Studies; D013063:Speech Discrimination Tests
D018389:Codon, Nonsense