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Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years.
Laryngoscope. 2004 Apr; 114(4):681-8.L

Abstract

OBJECTIVES/HYPOTHESIS

The aim of the study was to evaluate the incidence of short- and intermediate-term postoperative complications after vestibular schwannoma surgery.

STUDY DESIGN

Retrospective review in a tertiary referral center.

METHODS

In 400 patients who underwent surgical removal of vestibular schwannoma from 1984 to 2000,symptoms, preoperative evaluation, surgery, and postoperative complications were analyzed using standardized grading systems.

RESULTS

One hundred ninety-four men and 206 women had an operation. Mean age was 53.9 years (age range, 11-78 y). Tumor size according to Koos stage was stage 1 in 39 cases, stage 2 in 122 cases, stage 3 in 87 cases, and stage 4 in 152 cases. Preoperatively, 7.5% of patients had facial nerve dysfunction. Surgical approaches were translabyrinthine in 229 patients, widened retrolabyrinthine in 128 cases, suboccipital in 42 cases, and transotic in 1 case. Mortality was 0.5%. Facial nerve was transected in 15 cases (3.7%) and immediately repaired in 5 cases. A delayed hypoglossal-to-facial nerve anastomosis was performed in 12 cases. At 1 year, House-Brackmann grade in 70.7% of patients was 1 to 2; in 24.3%, 3 to 4; and in 5%, 5 to 6. Poor facial nerve outcome was correlated with tumor size, preoperative irradiation, and nerve dysfunction and was not correlated with the approach used. Most patients had postoperative dizziness, and 30% still had vestibular disturbances after 1 year. Nine patients (2.2%) had a cerebrospinal fluid rhinorrhea, and 24 had a cerebrospinal fluid wound leak (6%). Twenty-two patients (5.5%) had postoperative meningitis. Two patients had a cerebellopontine angle hemorrhage, and three a brainstem infarct.

CONCLUSION

Transpetrosal approaches (translabyrinthine, widened retrolabyrinthine) are safe for vestibular schwannoma removal, and rates of postoperative complications and sequelae are decreasing.

Authors+Show Affiliations

Department of Skull Base Surgery, University Hospital of Bordeaux, Bordeaux, France. vincent.darrouzet@chu-bordeax.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15064624

Citation

Darrouzet, Vincent, et al. "Vestibular Schwannoma Surgery Outcomes: Our Multidisciplinary Experience in 400 Cases Over 17 Years." The Laryngoscope, vol. 114, no. 4, 2004, pp. 681-8.
Darrouzet V, Martel J, Enée V, et al. Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope. 2004;114(4):681-8.
Darrouzet, V., Martel, J., Enée, V., Bébéar, J. P., & Guérin, J. (2004). Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. The Laryngoscope, 114(4), 681-8.
Darrouzet V, et al. Vestibular Schwannoma Surgery Outcomes: Our Multidisciplinary Experience in 400 Cases Over 17 Years. Laryngoscope. 2004;114(4):681-8. PubMed PMID: 15064624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. AU - Darrouzet,Vincent, AU - Martel,Jacques, AU - Enée,Véronique, AU - Bébéar,Jean-Pierre, AU - Guérin,Jean, PY - 2004/4/6/pubmed PY - 2004/5/12/medline PY - 2004/4/6/entrez SP - 681 EP - 8 JF - The Laryngoscope JO - Laryngoscope VL - 114 IS - 4 N2 - OBJECTIVES/HYPOTHESIS: The aim of the study was to evaluate the incidence of short- and intermediate-term postoperative complications after vestibular schwannoma surgery. STUDY DESIGN: Retrospective review in a tertiary referral center. METHODS: In 400 patients who underwent surgical removal of vestibular schwannoma from 1984 to 2000,symptoms, preoperative evaluation, surgery, and postoperative complications were analyzed using standardized grading systems. RESULTS: One hundred ninety-four men and 206 women had an operation. Mean age was 53.9 years (age range, 11-78 y). Tumor size according to Koos stage was stage 1 in 39 cases, stage 2 in 122 cases, stage 3 in 87 cases, and stage 4 in 152 cases. Preoperatively, 7.5% of patients had facial nerve dysfunction. Surgical approaches were translabyrinthine in 229 patients, widened retrolabyrinthine in 128 cases, suboccipital in 42 cases, and transotic in 1 case. Mortality was 0.5%. Facial nerve was transected in 15 cases (3.7%) and immediately repaired in 5 cases. A delayed hypoglossal-to-facial nerve anastomosis was performed in 12 cases. At 1 year, House-Brackmann grade in 70.7% of patients was 1 to 2; in 24.3%, 3 to 4; and in 5%, 5 to 6. Poor facial nerve outcome was correlated with tumor size, preoperative irradiation, and nerve dysfunction and was not correlated with the approach used. Most patients had postoperative dizziness, and 30% still had vestibular disturbances after 1 year. Nine patients (2.2%) had a cerebrospinal fluid rhinorrhea, and 24 had a cerebrospinal fluid wound leak (6%). Twenty-two patients (5.5%) had postoperative meningitis. Two patients had a cerebellopontine angle hemorrhage, and three a brainstem infarct. CONCLUSION: Transpetrosal approaches (translabyrinthine, widened retrolabyrinthine) are safe for vestibular schwannoma removal, and rates of postoperative complications and sequelae are decreasing. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/15064624/Vestibular_schwannoma_surgery_outcomes:_our_multidisciplinary_experience_in_400_cases_over_17_years_ DB - PRIME DP - Unbound Medicine ER -