Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Background: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression. Methods...

Full description

Saved in:
Bibliographic Details
Published in:Surgical neurology international 2017-01, Vol.8 (1), p.45-45
Main Authors: Harati, Ali, Scheufler, Kai-Michael, Schultheiss, Rolf, Tonkal, Albaraa, Harati, Kamran, Oni, Paul, Deitmer, Thomas
Format: Article
Language:English
Subjects:
Acoustics
Analysis
Electromyography
Hearing loss
Medical imaging
Microsurgery
NMR
Nuclear magnetic resonance
Patients
Skull Base: Original
Tumors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression. Methods: Forty-nine patients presented with VS (Hannover grading scale T4a or T4b) in our department. A subgroup analysis was performed among patients without (T4a) and with (T4b) compression and dislocation of the fourth ventricle. Results: Patients with type T4b VS presented significantly more often with long tract signs/ataxia (P < 0.05), tonsillar herniation (P < 0.001), and preoperative hydrocephalus (P < 0.01). No significant difference was found between the groups regarding hearing loss and facial nerve, trigeminal nerve, and lower cranial nerve function. Gross total resection was achieved in 83% of the cases, near total resection was achieved in 15% of the cases, and subtotal resection was performed in 2% of the cases. One patient died after massive postoperative bleeding caused by a coagulopathy. At last follow-up, 69% of the patients had excellent facial nerve function (Grade I-II) and the remaining 31% a fair outcome. Six patients (12%) required permanent ventriculoperitoneal shunting. Hearing was preserved in two patients. Forty-six patients (94%) were independent without occasional assistance (Karnofsky scale 70-100%). Conclusions: VS with brainstem compression is frequently associated with hydrocephalus, ataxia, long tract signs, multiple cranial nerve disorders, and occasionally, signs of intracranial hypertension. Primary microsurgical resection is an appropriate management option for large VS.
ISSN:2152-7806
2229-5097
2152-7806
DOI:10.4103/sni.sni_129_16