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.
