Surgical treatment of sporadic vestibular schwannoma in a series of 1006 patients.
The management of sporadic vestibular schwannoma (VS) has evolved in the last decades. The aim of this study was to analyse the evolution in surgical outcomes of VSs operated by a neurotological team between 1990 and 2006 by different approaches. A monocentric retrospective review of medical charts of 1006 patients was performed. In order to assess eventual changes and progress, the 17-years period was divided in three periods, each one comprehending 268 VS (1990-1996), 299 VS (1997-2001), and 439 VS (2002-2006). Mean follow-up was 5.9 ± 2.4 years. Overall, complete VS removal was achieved in 99.4% of cases. Mortality rate was 0.3%, meningitis and CSF leaks were observed in 1.2 % and 9 % of the cases, respectively. CSF leakage decreased from 11.6% to 7.1% between the first and last period (p < 0.01) as well as revision surgery from 3.4 % to 0.9 % (p < 0.05). Facial nerve was anatomically preserved in 97.7% of cases. At one year, a good facial nerve function was observed in 85.1% of patients (grade I and II of House-Brackmann grading scale), which ranged between the first and last period from 78.4% to 87.6% (p <0.05). At one year, hearing preservation was obtained in 61.6% of patients, which increased from the first period to the last one from 50.9% to 69.0% (p < 0.05) (class A+B+C from the AAO-HNS classification). Useful hearing (class A+B) was observed in 33.5% of cases overall, with 21.8% and 42% in the first and last period, respectively (p < 0.01). Surgical outcomes of sporadic vestibular schwannoma have improved concerning facial nerve function outcomes, hearing preservation and cerebrospinal fluid (CSF) leaks, mainly due to the neuro-otological team's experience. Functional results after complete microsurgical removal of large VS depend on experience gained on small VS removal.
AP-HP, Pitié-Salpêtrière Hospital, Department of Otology Auditory Implants and Skull Base Surgery, Paris, France.|Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital Shanghai Jiaotong Univerrsity School of Medicine, Shanghai, China.
Z
Z
Zhang
AP-HP, Pitié-Salpêtrière Hospital, Department of Otology Auditory Implants and Skull Base Surgery, Paris, France.
Y
Y
Nguyen
AP-HP, Pitié-Salpêtrière Hospital, Department of Otology Auditory Implants and Skull Base Surgery, Paris, France.
D
D
De Seta
AP-HP, Pitié-Salpêtrière Hospital, Department of Otology Auditory Implants and Skull Base Surgery, Paris, France.
F Y
FY
Russo
AP-HP, Beaujon Hospital, Department of Neurosurgery, Paris, France.
A
A
Rey
AP-HP, Pitié- Salpêtrière Hospital, Department of Neurosurgery, Paris, France.
M
M
Kalamarides
AP-HP, Pitié-Salpêtrière Hospital, Department of Otology Auditory Implants and Skull Base Surgery, Paris, France.
O
O
Sterkers
AP-HP, Pitié-Salpêtrière Hospital, Department of Otology Auditory Implants and Skull Base Surgery, Paris, France.
D
D
Bernardeschi
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Facial nerve; Hearing levels; Translabyrinthine; Vestibular schwannoma