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Microsurgical treatment of large and giant vestibular schwannomas with facial nerve function preservation as primary aim: retrospective analysis and literature review

Vigneul, Eric
(2019)

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Vigneul_Eric_17441200_2018-2019pdf.pdf
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Details

Supervisors
Raftopoulos, Christian ; Ribeiro Vaz, Jose-Geraldo ; Vincart, Hadrien
Faculty
Faculté de médecine et médecine dentaire
Degree label
Master [180] en médecine
Abstract
SUMMARY IN ENGLISH Objective: To evaluate our microsurgical results in the treatment of large and giant vestibular schwannomas (≥ 30 mm and ≥ 40 mm) when preservation of cranial nerve function was considered more important than total tumor removal. Particular focus was set on facial nerve (FN) function and tumor regrowth. Methods: Thirty patients were operated by five different neurosurgeons, via a retrosigmoid approach, using intraoperative neuro-monitoring (IONM) based on electromyographic and brain stem auditory evoked potential recordings. FN function was evaluated on the House-Brackmann Scale and cochlear nerve function on the Gardner-Robertson Scale. Results: FN was anatomically conserved in every patient. Preoperative House-Brackmann grade (HBG) I-II were kept in 80.8 % of them (100% for the most experienced neurosurgeon). Serviceable hearing (Gardner-Robertson Grade I or II) was preserved 28.6 % of the time. Resection rates were the following: 40% of gross total resection (GTR), 36.7% of near total resection (NTR), 16.7% of subtotal and 6.7% of partial resection. Every tumor, except for one patient, were stable at last follow-up. Our main surgical complications essentially happened while trying to remove vestibular schwannomas 50 mm or greater, with a statistically significative impairment of the FN function post-operative. Conclusion: When confronted with vestibular schwannomas of 30 mm or greater, our neurosurgical team was able to perform GTR or NTR in 76.7% while keeping preoperative HBG I and II in 80.7%. The loss of socially acceptable FN function (HBG I-II) occurred 75% of the time when dealing with vestibular schwannomas of 50 mm or greater. In those cases, trying to perform a GTR or NTR should be avoided.