J Neurol Surg B Skull Base 2017; 78(S 01): S1-S156
DOI: 10.1055/s-0037-1600537
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Trends of Change in the Management of Vestibular Schwannoma

Andrew F. Alalade
1   The National Hospital for Neurology and Neurosurgery, London, United Kingdom
,
Nagina Subrati
1   The National Hospital for Neurology and Neurosurgery, London, United Kingdom
,
Shakeel Saeed
2   Royal National Throat, Nose and Ear Hospital, London, United Kingdom
,
Robert Bradford
1   The National Hospital for Neurology and Neurosurgery, London, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
02 March 2017 (online)

 

Objectives: The management of vestibular schwannomas (VS) continues to evolve over the years, Prompt diagnosis, multidisciplinary mode of management, improved diagnostic tools and availability of varied management modalities have changed the management of this skull base pathology in recent times. The authors report their experience in the management of VS over the past 5 years, correlating outcomes with treatment options and comparing results with those in medical literature.

Design: Retrospective case series review

Subjects: All patients with vestibular schwannomas referred over a 5 year period.

Methods: Database interrogation of patients with VS who have been managed by the Skull Base team across two (2) tertiary neurosurgical institutions. Patients had electronic and paper notes analyzed to identify presenting clinical features, tumor size, treatment options used, postoperative complications, secondary treatment if applicable etc. Overall, this comprised of 494 patients.

Results: Retrosigmoid approach (RS) was used primarily in 64 patients (12.9%), translabyrinthine approach (TL) in 70 patients (14.1%), stereotactic radiosurgery (SRS) in 103 cases (21%) and surveillance in 176 cases (35.6%). This was compared with the 728 cases of the preceding 22 years where the retrosigmoid approach (RS) was used in the majority (46%) of the patients; the translabyrinthine approach (TL) was used in 16% of the patients, stereotactic radiosurgery (SRS) in 10% and surveillance monitoring in 25%. Several factors e.g., tumors size, treatment outcomes and complications were analyzed and compared. There has been an increasing emphasis on facial nerve preservation with stereotactic radiosurgery utilized for residual tumors.

Conclusions: A multidisciplinary skull base team-based approach with careful selection and specific patient-centered discussion(s) was applied to every case. Emphasis has shifted to CN VII / hearing preservation, and there has been an increasing use of the SRS and surveillance treatment options over the years. Our complication rates are concordant with those in current literature.