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Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms.
J Neurosurg. 2017 May; 126(5):1514-1519.JN

Abstract

OBJECTIVE The aim of this study was to analyze the efficacy and risks of microsurgery via the hearing-preserving retrosigmoid approach in patients with intracanalicular vestibular schwannoma (VS) suffering from disabling vestibular symptoms, with special attention to vertigo. METHODS This is a retrospective analysis of 19 patients with intracanalicular VS and disabling vestibular dysfunction as the main or only symptom (Group A). All of the patients reported having had disabling vertigo attacks. Subjective evaluation of the impairment of patients was performed before surgery, 3 weeks after surgery, 3 months after surgery, and 1 year after surgery, using the Dizziness Handicap Inventory (DHI). The main outcome measures were improvement in quality of life as measured using the DHI, and general and functional outcomes, in particular facial function and hearing. Patient age, preoperative tumor size, preoperative DHI score, and preservation of the nontumorous vestibular nerve were tested using a multivariate regression analysis to determine factors affecting the postoperative DHI score. The Mann-Whitney U-test was used to compare the postoperative DHI score at 3 weeks, 3 months, and 1 year after surgery with a control group of 19 randomly selected patients with intracanalicular VSs, who presented without vestibular symptoms (Group B). The occurrence of early postoperative discrete vertigo attacks was also compared between groups. RESULTS The preoperative DHI score was ≥ 54 in all patients. All patients reported having had disabling rotational vertigo before surgery. The only significant factor to affect the DHI outcome 3 weeks and 3 months after surgery was the preoperative DHI score. The DHI outcome after 1 year was not affected by the preoperative DHI score. Compared with the control group, the DHI score at 3 weeks and 3 months after surgery was significantly worse. There was no significant difference between the groups after 1 year. Vertigo was improved in all patients and completely resolved after 1 year in 17 patients. CONCLUSIONS Disabling vestibular dysfunction that affects quality of life should be considered an indication for surgery, even in otherwise asymptomatic patients with intracanalicular VS. Surgical removal of the tumor is safe and very effective in regard to symptom relief. All patients had excellent facial nerve function within 1 year after surgery, with a very good chance of hearing preservation.

Authors+Show Affiliations

International Neuroscience Institute, Hannover, Germany.International Neuroscience Institute, Hannover, Germany.International Neuroscience Institute, Hannover, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27315031

Citation

Samii, Madjid, et al. "Efficacy of Microsurgical Tumor Removal for Treatment of Patients With Intracanalicular Vestibular Schwannoma Presenting With Disabling Vestibular Symptoms." Journal of Neurosurgery, vol. 126, no. 5, 2017, pp. 1514-1519.
Samii M, Metwali H, Gerganov V. Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms. J Neurosurg. 2017;126(5):1514-1519.
Samii, M., Metwali, H., & Gerganov, V. (2017). Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms. Journal of Neurosurgery, 126(5), 1514-1519. https://doi.org/10.3171/2016.4.JNS153020
Samii M, Metwali H, Gerganov V. Efficacy of Microsurgical Tumor Removal for Treatment of Patients With Intracanalicular Vestibular Schwannoma Presenting With Disabling Vestibular Symptoms. J Neurosurg. 2017;126(5):1514-1519. PubMed PMID: 27315031.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms. AU - Samii,Madjid, AU - Metwali,Hussam, AU - Gerganov,Venelin, Y1 - 2016/06/17/ PY - 2016/6/18/pubmed PY - 2019/9/5/medline PY - 2016/6/18/entrez KW - BAEP = brainstem auditory evoked potential KW - DHI = Dizziness Handicap Inventory KW - VS = vestibular schwannoma KW - dizziness KW - facial nerve KW - hearing preservation KW - outcome KW - quality of life KW - vertigo KW - vestibular nerve KW - vestibular schwannoma SP - 1514 EP - 1519 JF - Journal of neurosurgery JO - J Neurosurg VL - 126 IS - 5 N2 - OBJECTIVE The aim of this study was to analyze the efficacy and risks of microsurgery via the hearing-preserving retrosigmoid approach in patients with intracanalicular vestibular schwannoma (VS) suffering from disabling vestibular symptoms, with special attention to vertigo. METHODS This is a retrospective analysis of 19 patients with intracanalicular VS and disabling vestibular dysfunction as the main or only symptom (Group A). All of the patients reported having had disabling vertigo attacks. Subjective evaluation of the impairment of patients was performed before surgery, 3 weeks after surgery, 3 months after surgery, and 1 year after surgery, using the Dizziness Handicap Inventory (DHI). The main outcome measures were improvement in quality of life as measured using the DHI, and general and functional outcomes, in particular facial function and hearing. Patient age, preoperative tumor size, preoperative DHI score, and preservation of the nontumorous vestibular nerve were tested using a multivariate regression analysis to determine factors affecting the postoperative DHI score. The Mann-Whitney U-test was used to compare the postoperative DHI score at 3 weeks, 3 months, and 1 year after surgery with a control group of 19 randomly selected patients with intracanalicular VSs, who presented without vestibular symptoms (Group B). The occurrence of early postoperative discrete vertigo attacks was also compared between groups. RESULTS The preoperative DHI score was ≥ 54 in all patients. All patients reported having had disabling rotational vertigo before surgery. The only significant factor to affect the DHI outcome 3 weeks and 3 months after surgery was the preoperative DHI score. The DHI outcome after 1 year was not affected by the preoperative DHI score. Compared with the control group, the DHI score at 3 weeks and 3 months after surgery was significantly worse. There was no significant difference between the groups after 1 year. Vertigo was improved in all patients and completely resolved after 1 year in 17 patients. CONCLUSIONS Disabling vestibular dysfunction that affects quality of life should be considered an indication for surgery, even in otherwise asymptomatic patients with intracanalicular VS. Surgical removal of the tumor is safe and very effective in regard to symptom relief. All patients had excellent facial nerve function within 1 year after surgery, with a very good chance of hearing preservation. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/27315031/Efficacy_of_microsurgical_tumor_removal_for_treatment_of_patients_with_intracanalicular_vestibular_schwannoma_presenting_with_disabling_vestibular_symptoms_ DB - PRIME DP - Unbound Medicine ER -