Abstract
One hundred sixty consecutive patients (mean age, 49.9 years) were operated at San Filippo Neri Hospital, Rome, between September 2010 and April 2018. Mean tumor size was 23.3 mm. One hundred thirty-five patients (84.4%) had completely preserved facial nerve function (HB 1) before surgery; 56 (35%) patients had preoperative serviceable hearing (AAO-HNS classes A/B). Retrosigmoid approach was performed in all the cases except for one, wherein the patient underwent a translabyrinthine approach. The total or near-total (thin capsule residue left on the brainstem) resection rate was obtained in majority of cases. In the last 14 surgical procedures, a flexible endoscope was employed for final check in the IAC. At 6 months after surgery, 149 (93.7%) patients had HB 1 or facial nerve function. Among 56 patients who had serviceable hearing before surgery, 35 retained it, thus yielding a hearing preservation rate of 62.5%. In 63 procedures, diluted topical papaverine was used for improving the blood flow in microvasculature of cranial nerves.
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References
House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146–7.
Gardner G, Robertson JH. Hearing preservation in unilateral acoustic neuroma surgery. Ann Otol Rhinol Laryngol. 1988;97(1):55–66.
Hoa M, Drazin D, Hanna G, Schwartz MS, Lekovic GP. The approach to the patient with incidentally diagnosed vestibular schwannoma. Neurosurg Focus. 2012;33(3):E2.
Nejo T, Kohno M, Nagata O, Sora S, Sato H. Dorsal displacement of the facial nerve in acoustic neuroma surgery: clinical features and surgical outcomes of 21 consecutive dorsal pattern cases. Neurosurg Rev. 2016;39(2):277–88; discussion 88.
Mastronardi L, Cacciotti G, Roperto R, Di Scipio E, Tonelli MP, Carpineta E. Position and course of facial nerve and postoperative facial nerve results in vestibular schwannoma microsurgery. World Neurosurg. 2016;94:174–80.
Sameshima T, Morita A, Tanikawa R, Fukushima T, Friedman AH, Zenga F, et al. Evaluation of variation in the course of the facial nerve, nerve adhesion to tumors, and postoperative facial palsy in acoustic neuroma. J Neurol Surg B Skull Base. 2013;74(1):39–43.
Corrivetti F, Cacciotti G, Scavo CG, Roperto R, Mastronardi L. Flexible endoscopic-assisted microsurgical radical resection of intracanalicular vestibular schwannomas by retrosigmoid approach: operative technique. World Neurosurg. 2018;115:229–33.
Mastronardi L, Cacciotti G, Scipio ED, Parziale G, Roperto R, Tonelli MP, et al. Safety and usefulness of flexible hand-held laser fibers in microsurgical removal of acoustic neuromas (vestibular schwannomas). Clin Neurol Neurosurg. 2016;145:35–40.
Mastronardi L, Cacciotti G, Roperto R, Tonelli MP, Carpineta E, How I. Do it: the role of flexible hand-held 2μ-thulium laser fiber in microsurgical removal of acoustic neuromas. J Neurol Surg B Skull Base. 2017;78(4):301–7.
Cardoso AC, Fernandes YB, Ramina R, Borges G. Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position. Arq Neuropsiquiatr. 2007;65(3A):605–9.
Roessler K, Krawagna M, Bischoff B, Rampp S, Ganslandt O, Iro H, et al. Improved postoperative facial nerve and hearing function in retrosigmoid vestibular schwannoma surgery significantly associated with semisitting position. World Neurosurg. 2016;87:290–7.
Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg. 2006;105(4):527–35.
Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve–preservation and restitution of function. Neurosurgery. 1997;40(4):684–94; discussion 94–5.
Tatagiba MS, Roser F, Hirt B, Ebner FH. The retrosigmoid endoscopic approach for cerebellopontine-angle tumors and microvascular decompression. World Neurosurg. 2014;82(6 Suppl):S171–6.
Tatagiba M, Roser F, Schuhmann MU, Ebner FH. Vestibular schwannoma surgery via the retrosigmoid transmeatal approach. Acta Neurochir. 2014;156(2):421–5; discussion 5.
Yang J, Grayeli AB, Barylyak R, Elgarem H. Functional outcome of retrosigmoid approach in vestibular schwannoma surgery. Acta Otolaryngol. 2008;128(8):881–6.
Ahsan SF, Huq F, Seidman M, Taylor A. Long-term hearing preservation after resection of vestibular schwannoma: a systematic review and meta-analysis. Otol Neurotol. 2017;38(10):1505–11.
Mazzoni A, Zanoletti E, Calabrese V. Hearing preservation surgery in acoustic neuroma: long-term results. Acta Otorhinolaryngol Ital. 2012;32(2):98–102.
Nakamizo A, Mori M, Inoue D, Amano T, Mizoguchi M, Yoshimoto K, et al. Long-term hearing outcome after retrosigmoid removal of vestibular schwannoma. Neurol Med Chir (Tokyo). 2013;53(10):688–94.
Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus. 2012;33(3):E14.
Bennett M, Haynes DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin N Am. 2007;40(3):589–609, ix–x.
Nonaka Y, Fukushima T, Watanabe K, Friedman AH, Sampson JH, Mcelveen JT, et al. Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery. 2013;72(2 Suppl Operative):ons103–15; discussion ons15.
Mastronardi L, Cacciotti G, Caputi F, Roperto R, Tonelli MP, Carpineta E, et al. Underlay hourglass-shaped autologous pericranium duraplasty in “key-hole” retrosigmoid approach surgery: technical report. Surg Neurol Int. 2016;7:25.
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Mastronardi, L., Campione, A., Cacciotti, G., Roperto, R., Giacobbo Scavo, C. (2019). Results in a Personal Series of 160 Cases. In: Mastronardi, L., Fukushima, T., Campione, A. (eds) Advances in Vestibular Schwannoma Microneurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-03167-1_8
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