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Facial nerve function and hearing after microsurgical removal of sporadic vestibular schwannomas in a population-based cohort.

Abstract：

BACKGROUND:Vestibular schwannoma (VS) is a benign tumor originating from the vestibulocochlear nerve. The optimal treatment strategy is debated, since surgery may result in iatrogenic facial nerve injury. We report the results of VS surgery in a population-based unselected cohort in a center with access to Cyber Knife (CK) radiosurgery. METHODS:We reviewed 117 consecutive operations and found 95 patients who had their primary operation due to vestibular schwannoma between 2001 and 2017. Facial nerve function was evaluated with the House-Brackmann (HB) scale and hearing with the EU classification. RESULTS:The population consisted of 37 males and 58 females with a median age of 54 years (range 19-79). One year after surgery 67% of patients had a good outcome (HB 1-2). The rate of good outcome was 90% if no facial nerve damage was observed during intraoperative monitoring, the size of the tumor was under 30 mm and no hydrocephalus was present. During the study period, the treatment strategy changed from total to near-total resection after the introduction of CK radiosurgery, which could be used as a second-line treatment in case of residual tumor regrowth. This resulted in an improvement of outcomes (0% HB 5-6) despite the larger tumor sizes (25 ± 14 mm vs. 31 ± 9 mm, p < 0.05). Hearing preservation rates did not increase. CONCLUSIONS:Near-total resection and subsequent CK radiosurgery in case of residual tumor regrowth during follow-up seems to provide a good outcome of facial nerve function even in large VSs.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Taha I,Hyvärinen A,Ranta A,Kämäräinen OP,Huttunen J,Mervaala E,Löppönen H,Rauramaa T,Ronkainen A,Jääskeläinen JE,Immonen A,Danner N

doi

10.1007/s00701-019-04055-4

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

43-54

issue

1

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-019-04055-4

journal_volume

162

pub_type

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