The Vestibular Schwannoma Surgery Learning Curve: Modern Series of a Young Neurosurgeon

Objective: To demonstrate and quantify the learning curve for microsurgical removal of vestibular schwannoma by a young surgeon.

Methods: We reviewed all cases vestibular schwannoma operated by the senior author between October 2006 and May 2015. Health-related Quality of life was analyzed using the EuroQOL questioner at last follow via telephone interview.

Results: 112 consecutive cases from October 2006 to May 2014 were identified. The senior author performed all surgeries. 39% were male, 61% female; mean age was 58 years (range 18–85). According to the Hannover Classification, 9% were rated as T1, 16% as T2, 34% as T3, and 41% as T4. Six patients (5%) had previous surgery, eight patients (7%) had radiotherapy and 2 patients had both surgery and radiotherapy. Complete and subtotal resections were achieved in 71% and 29% of cases, respectively. Newly developed postoperative facial nerve palsy was seen in 13 cases (11%). 10 of those 13 cases (77%) were seen during the first 40 surgeries. Hearing preservation in T1/2 schwannomas was achieved in 80%, in patients with T3 tumors in 81%, and in large T4 tumors in 65%. Six patients suffered a cerebrospinal fluid fistula (5%), one patient required a ventriculoperitoneal Shunt follow surgery.

Conclusion: The learning curve in our series was evident. Facial nerve preservation correlated with surgical experience. Hearing preservation was more associated with tumor size.