Functional outcome after complete surgical removal of giant vestibular schwannomas.
OBJECTIVE
The authors evaluated the outcome of radical surgery in a consecutive series of patients with giant vestibular schwannomas (VSs).


METHODS
Fifty patients with VSs > 4.0 cm in maximal extrameatal diameter were included in this retrospective study (Group A). The group was compared with a matched group of 167 patients with VSs < 3.9 cm (Group B). In all cases the retrosigmoid approach was used. Outcome measures included completeness of tumor removal, facial nerve function, hearing, and the surgery-related complication rate.


RESULTS
The mean tumor size in Group A was 4.4 cm and that in Group B was 2.3 cm. Total removal was achieved in all Group A patients and in 97.6% of Group B patients. The anatomical integrity of the facial nerve was preserved in 92% in Group A and in 98.8% in Group B. At last follow-up 75% of the patients with giant VSs had excellent or good facial nerve function, 19% had fair function, and 6% had poor function. In 33% of patients (3 cases) with good preoperative hearing level, it was preserved. Newly developed lower cranial nerve dysfunction occurred in 3 patients but proved to be temporary in 2 of them. A CSF leak developed in 6% of those who not previously undergone surgery. Compared with Group B, a significant difference was found only in the rates of the following parameters: excellent facial nerve function, useful and good hearing, lower cranial nerve dysfunction, and blood collection (p < 0.05). The perioperative mortality rate in both groups was 0%.


CONCLUSIONS
In patients with a giant VS, total tumor removal can be achieved via the retrosigmoid approach with a 0% mortality rate and low morbidity rate, especially with regards to facial nerve function. In selected cases even hearing preservation is possible. Tumor size significantly correlates with postoperative outcome.
Samii
Madjid
M
International Neuroscience Institute, Hannover, Germany.
Gerganov
Venelin M
VM
Samii
Amir
A
D000328:Adult; D000368:Aged; D003056:Cochlear Nerve / Q000502:physiology; D005154:Facial Nerve / Q000502:physiology; D005155:Facial Nerve Diseases / Q000453:epidemiology; D005260:Female; D006309:Hearing; D034381:Hearing Loss / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009464:Neuroma, Acoustic / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000160:Vestibulocochlear Nerve Diseases / Q000453:epidemiology; D055815:Young Adult