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Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach

Introduction Vestibular schwannomas (VS) are the most common benign neoplasms of a cerebellopontine angle (CPA), which arise from the Schwann cells of the vestibulocochlear nerve. Eighty percent of CPA tumors are VS followed by meningioma as the second common mass lesion in this critical potential s...

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Autores principales: Rajput, Muhammad Shaheryar Ahmed, Ahmad, Ahmad Nawaz, Arain, Asif Ali, Adeel, Mohammad, Akram, Saeed, Awan, Muhammad Sohail, Bari, Muhammad Ehsan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367112/
https://www.ncbi.nlm.nih.gov/pubmed/30761236
http://dx.doi.org/10.7759/cureus.3684
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author Rajput, Muhammad Shaheryar Ahmed
Ahmad, Ahmad Nawaz
Arain, Asif Ali
Adeel, Mohammad
Akram, Saeed
Awan, Muhammad Sohail
Bari, Muhammad Ehsan
author_facet Rajput, Muhammad Shaheryar Ahmed
Ahmad, Ahmad Nawaz
Arain, Asif Ali
Adeel, Mohammad
Akram, Saeed
Awan, Muhammad Sohail
Bari, Muhammad Ehsan
author_sort Rajput, Muhammad Shaheryar Ahmed
collection PubMed
description Introduction Vestibular schwannomas (VS) are the most common benign neoplasms of a cerebellopontine angle (CPA), which arise from the Schwann cells of the vestibulocochlear nerve. Eighty percent of CPA tumors are VS followed by meningioma as the second common mass lesion in this critical potential space. Treatment options range from watchful waiting with serial imaging studies to radiosurgery or a microsurgical excision or a combination of surgery and radiation therapy. The primary objective of the study was to assess hearing and facial nerve status before and after the surgery via the retrosigmoid approach. Methods The database of Aga Khan University Hospital was searched for diagnoses of vestibular schwannomas between 2000 and 2007. A total of 35 patients were identified; among them, 27 were selected for the study who met the inclusion criteria. The variables of the study were age, gender, presenting symptoms, size of the tumor, surgical approach, hearing levels, and facial nerve function. Hearing loss was categorized according to the Gardener-Robertson hearing classification and the House-Brackmann Scale was used for facial nerve assessment. Results Out of the 27 patients, 18 were male and nine were female. The mean age was 43 years. The most common presenting complaint was hearing loss and tinnitus, seen in 21 patients. Headache was present in six patients, ataxia in five, and vertigo in three. Facial nerve weakness was noticed in six patients. Two patients had Grade-III paralysis, three had Grade-IV paralysis, and one had Grade-V paralysis. The audiogram confirmed the presence of sensorineural hearing loss (SNHL) in all patients. Twelve patients out of 27 had Class II hearing with the threshold between 31 and 50 decibels and a Speech Discrimination Score (SDS) of 50% to 69%. Ten patients had non-serviceable hearing and the remaining five had poor hearing. The audiogram was repeated after surgery for those 12 patients who had Class II hearing and showed that seven out of 12 patients maintained a hearing threshold within the range of Class II at the one-year follow-up (hearing preservation 58%). The facial nerve preservation rate was 56% considering House-Brackmann Grade III or less as acceptable facial nerve function. Conclusion The optimal treatment for small vestibular schwannomas is a matter of controversy; however, the choice of treatment for large vestibular schwannomas in patients without significant comorbidity is generally microsurgical excision. The surgical excision of a large VS with the retrosigmoid approach is found to be safe consistently. The hearing and facial nerve preservation in our study were found comparable with the literature.
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spelling pubmed-63671122019-02-13 Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach Rajput, Muhammad Shaheryar Ahmed Ahmad, Ahmad Nawaz Arain, Asif Ali Adeel, Mohammad Akram, Saeed Awan, Muhammad Sohail Bari, Muhammad Ehsan Cureus Otolaryngology Introduction Vestibular schwannomas (VS) are the most common benign neoplasms of a cerebellopontine angle (CPA), which arise from the Schwann cells of the vestibulocochlear nerve. Eighty percent of CPA tumors are VS followed by meningioma as the second common mass lesion in this critical potential space. Treatment options range from watchful waiting with serial imaging studies to radiosurgery or a microsurgical excision or a combination of surgery and radiation therapy. The primary objective of the study was to assess hearing and facial nerve status before and after the surgery via the retrosigmoid approach. Methods The database of Aga Khan University Hospital was searched for diagnoses of vestibular schwannomas between 2000 and 2007. A total of 35 patients were identified; among them, 27 were selected for the study who met the inclusion criteria. The variables of the study were age, gender, presenting symptoms, size of the tumor, surgical approach, hearing levels, and facial nerve function. Hearing loss was categorized according to the Gardener-Robertson hearing classification and the House-Brackmann Scale was used for facial nerve assessment. Results Out of the 27 patients, 18 were male and nine were female. The mean age was 43 years. The most common presenting complaint was hearing loss and tinnitus, seen in 21 patients. Headache was present in six patients, ataxia in five, and vertigo in three. Facial nerve weakness was noticed in six patients. Two patients had Grade-III paralysis, three had Grade-IV paralysis, and one had Grade-V paralysis. The audiogram confirmed the presence of sensorineural hearing loss (SNHL) in all patients. Twelve patients out of 27 had Class II hearing with the threshold between 31 and 50 decibels and a Speech Discrimination Score (SDS) of 50% to 69%. Ten patients had non-serviceable hearing and the remaining five had poor hearing. The audiogram was repeated after surgery for those 12 patients who had Class II hearing and showed that seven out of 12 patients maintained a hearing threshold within the range of Class II at the one-year follow-up (hearing preservation 58%). The facial nerve preservation rate was 56% considering House-Brackmann Grade III or less as acceptable facial nerve function. Conclusion The optimal treatment for small vestibular schwannomas is a matter of controversy; however, the choice of treatment for large vestibular schwannomas in patients without significant comorbidity is generally microsurgical excision. The surgical excision of a large VS with the retrosigmoid approach is found to be safe consistently. The hearing and facial nerve preservation in our study were found comparable with the literature. Cureus 2018-12-04 /pmc/articles/PMC6367112/ /pubmed/30761236 http://dx.doi.org/10.7759/cureus.3684 Text en Copyright © 2018, Rajput et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Otolaryngology
Rajput, Muhammad Shaheryar Ahmed
Ahmad, Ahmad Nawaz
Arain, Asif Ali
Adeel, Mohammad
Akram, Saeed
Awan, Muhammad Sohail
Bari, Muhammad Ehsan
Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach
title Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach
title_full Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach
title_fullStr Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach
title_full_unstemmed Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach
title_short Preservation of Hearing and Facial Nerve Function with the Microsurgical Excision of Large Vestibular Schwannomas: Experience with the Retrosigmoid Approach
title_sort preservation of hearing and facial nerve function with the microsurgical excision of large vestibular schwannomas: experience with the retrosigmoid approach
topic Otolaryngology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367112/
https://www.ncbi.nlm.nih.gov/pubmed/30761236
http://dx.doi.org/10.7759/cureus.3684
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