title: Small Vestibular Schwannomas: Does Surgery Remain a Viable Treatment Option?
abstract: Background Surgery for small vestibular schwannomas (Koos grade I and II) has been increasingly rejected as the optimal primary treatment, instead favoring radiosurgery and observation that offer lower morbidity and potentially equal efficacy. Our study assesses the outcomes of contemporary surgical strategies including tumor control, functional preservation, and implications of pathologic findings. Design Retrospective review. Setting/Participants Eighty consecutive patients (45 women, 35 men; mean: 47 years of age). Main Outcomes Measures Approaches included retrosigmoid approach (52%), translabyrinthine (40%), and middle fossa (8%). Operated on by the same surgical team, we analyzed presentation, radiographic imaging, surgical data, and outcomes. Results At last follow-up (mean: 34 months), 95% had good facial nerve function (House-Brackmann grade I or II); 36% who presented with serviceable hearing retained it; and 93% who presented with vestibular dysfunction reported resolution. Pathology identified two grade I meningiomas. Conclusions As one of the largest contemporary surgical series of small vestibular schwannomas, we discuss some nuances to help refine treatment algorithms. Although observation and radiosurgery have established roles, our results reinforce microsurgery as a viable, safe option for a subgroup of patients.
authors.affiliation: Departments of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States; Brain Tumor Center, UC Neuroscience Institute, Cincinnati, Ohio, United States; Department of Neurosurgery, Georgetown University, Washington, DC, United States.
authors.forename: Amjad N
authors.initials: AN
authors.lastname: Anaizi
authors.affiliation: Departments of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States; Brain Tumor Center, UC Neuroscience Institute, Cincinnati, Ohio, United States.
authors.forename: Vincent V
authors.initials: VV
authors.lastname: DiNapoli
authors.affiliation: Brain Tumor Center, UC Neuroscience Institute, Cincinnati, Ohio, United States; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States.
authors.forename: Myles
authors.initials: M
authors.lastname: Pensak
authors.affiliation: Departments of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States; Brain Tumor Center, UC Neuroscience Institute, Cincinnati, Ohio, United States; Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States; Mayfield Clinic, Cincinnati, Ohio, United States.
authors.forename: Philip V
authors.initials: PV
authors.lastname: Theodosopoulos
keywords: acoustic neuroma; disequilibrium; dizziness; facial nerve function; hearing preservation; outcomes; quality of life; vestibular dysfunction