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Outcome of translabyrinthine surgery for vestibular schwannoma in neurofibromatosis type 2.
Br J Neurosurg. 2013 Aug; 27(4):446-53.BJ

Abstract

OBJECTIVES

To analyse the long-term outcome of translabyrinthine surgery for vestibular schwannoma (VS) in neurofibromatosis type 2 (NF2). RESEARCH TYPE: Retrospective cohort study.

SETTING

Two tertiary referral NF2 units.

PATIENTS

One hundred and forty eight translabyrinthine operations for patients with VS were performed. Preoperative stereotactic radiotherapy had been performed on 12(9.4%) patients.

RESULTS

Mean tumour size was 3.1 cm. Total tumour excision was achieved in 66% of cases, capsular remnants were left in 24% of cases, and subtotal excision was achieved in 5% and partial removal was achieved in 5%. The radiological residual/recurrence rate was 13.9%. The perioperative mortality was 1.6%. At 2 years postoperatively, facial function was expressed in terms of House-Brackmann score (HB): HB 1 in 53.4%, HB 1/2 in 61.3%, HB 1-3 in 83.2% and HB 4-6 in 16.8%. All nine patients who underwent surgery following failed stereotactic radiotherapy had HB 3 function or better. Among 9.5% of the cases, 14 facial nerves were lost during surgery and repaired using direct anastomosis or grafting. There was no tinnitus present preoperatively in 27% of the cases, and 22% of patients developed tinnitus postoperatively. In patients with preoperative tinnitus, 61% remained the same, 17% got it resolved and only in 21% it worsened. The preoperative hydrocephalus rate was 26%, and among 15% of the cases five ventriculo-peritoneal (VP) shunts were performed. The cerebrospinal fluid leak rate was 2.5%. Fifty-six patients underwent auditory brainstem implantation (ABI) and two patients had cochlear implant (CI) sleepers inserted.

CONCLUSIONS

The management of patients with NF2 presents the clinician with a formidable challenge with many patients still presenting themselves late with the neurological compromise and a large tumour load. There is still an argument for the management by observation until the neurological compromise dictates interventional treatment particularly with the option of hearing rehabilitation with ABI or CI. The translabyrinthine approach provides a very satisfactory means of reducing the overall tumour volume.

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Publisher Full Text

Authors+Show Affiliations

Moffat DA
Department of Skull Base Surgery, Addenbrookes Hospital, Cambridge University Teaching Hospitals NHS Trust , Cambridge , UK.
Lloyd SK
No affiliation info available
Macfarlane R
No affiliation info available
Mannion R
No affiliation info available
King A
No affiliation info available
Rutherford S
No affiliation info available
Axon PR
No affiliation info available
Donnelly N
No affiliation info available
Freeman S
No affiliation info available
Tysome JR
No affiliation info available
Evans DG
No affiliation info available
Ramsden RT
No affiliation info available

MeSH

AdolescentAdultAgedAuditory Brain Stem ImplantationChildCochlear ImplantsFacial NerveFemaleFollow-Up StudiesHearing TestsHumansMaleMiddle AgedNeoplasm Recurrence, LocalNeurofibromatosis 2Neurosurgical ProceduresPostoperative ComplicationsQuality of LifeRadiosurgeryRetrospective StudiesSeverity of Illness IndexTinnitusTreatment OutcomeVestibule, LabyrinthYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23472624

Citation

Moffat, D A., et al. "Outcome of Translabyrinthine Surgery for Vestibular Schwannoma in Neurofibromatosis Type 2." British Journal of Neurosurgery, vol. 27, no. 4, 2013, pp. 446-53.
Moffat DA, Lloyd SK, Macfarlane R, et al. Outcome of translabyrinthine surgery for vestibular schwannoma in neurofibromatosis type 2. Br J Neurosurg. 2013;27(4):446-53.
Moffat, D. A., Lloyd, S. K., Macfarlane, R., Mannion, R., King, A., Rutherford, S., Axon, P. R., Donnelly, N., Freeman, S., Tysome, J. R., Evans, D. G., & Ramsden, R. T. (2013). Outcome of translabyrinthine surgery for vestibular schwannoma in neurofibromatosis type 2. British Journal of Neurosurgery, 27(4), 446-53. https://doi.org/10.3109/02688697.2013.771143
Moffat DA, et al. Outcome of Translabyrinthine Surgery for Vestibular Schwannoma in Neurofibromatosis Type 2. Br J Neurosurg. 2013;27(4):446-53. PubMed PMID: 23472624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of translabyrinthine surgery for vestibular schwannoma in neurofibromatosis type 2. AU - Moffat,D A, AU - Lloyd,S K W, AU - Macfarlane,R, AU - Mannion,R, AU - King,A, AU - Rutherford,S, AU - Axon,P R, AU - Donnelly,N, AU - Freeman,S, AU - Tysome,J R, AU - Evans,D G, AU - Ramsden,R T, Y1 - 2013/03/08/ PY - 2013/3/12/entrez PY - 2013/3/12/pubmed PY - 2014/8/13/medline SP - 446 EP - 53 JF - British journal of neurosurgery JO - Br J Neurosurg VL - 27 IS - 4 N2 - OBJECTIVES: To analyse the long-term outcome of translabyrinthine surgery for vestibular schwannoma (VS) in neurofibromatosis type 2 (NF2). RESEARCH TYPE: Retrospective cohort study. SETTING: Two tertiary referral NF2 units. PATIENTS: One hundred and forty eight translabyrinthine operations for patients with VS were performed. Preoperative stereotactic radiotherapy had been performed on 12(9.4%) patients. RESULTS: Mean tumour size was 3.1 cm. Total tumour excision was achieved in 66% of cases, capsular remnants were left in 24% of cases, and subtotal excision was achieved in 5% and partial removal was achieved in 5%. The radiological residual/recurrence rate was 13.9%. The perioperative mortality was 1.6%. At 2 years postoperatively, facial function was expressed in terms of House-Brackmann score (HB): HB 1 in 53.4%, HB 1/2 in 61.3%, HB 1-3 in 83.2% and HB 4-6 in 16.8%. All nine patients who underwent surgery following failed stereotactic radiotherapy had HB 3 function or better. Among 9.5% of the cases, 14 facial nerves were lost during surgery and repaired using direct anastomosis or grafting. There was no tinnitus present preoperatively in 27% of the cases, and 22% of patients developed tinnitus postoperatively. In patients with preoperative tinnitus, 61% remained the same, 17% got it resolved and only in 21% it worsened. The preoperative hydrocephalus rate was 26%, and among 15% of the cases five ventriculo-peritoneal (VP) shunts were performed. The cerebrospinal fluid leak rate was 2.5%. Fifty-six patients underwent auditory brainstem implantation (ABI) and two patients had cochlear implant (CI) sleepers inserted. CONCLUSIONS: The management of patients with NF2 presents the clinician with a formidable challenge with many patients still presenting themselves late with the neurological compromise and a large tumour load. There is still an argument for the management by observation until the neurological compromise dictates interventional treatment particularly with the option of hearing rehabilitation with ABI or CI. The translabyrinthine approach provides a very satisfactory means of reducing the overall tumour volume. SN - 1360-046X UR - https://www.unboundmedicine.com/medline/citation/23472624/Outcome_of_translabyrinthine_surgery_for_vestibular_schwannoma_in_neurofibromatosis_type_2_ L2 - https://www.tandfonline.com/doi/full/10.3109/02688697.2013.771143 DB - PRIME DP - Unbound Medicine ER -