Humans ; Neuroma, Acoustic ; surgery

Humans ; Neuroma, Acoustic ; surgery ; therapy

47 studied cases aged from 18 to 75 years with a prevailing of women against men were diagnosed by CT-scanning and by MRI. The function of VIII nerve was assessed by clinical examination and by audiogramme. Tumors of VIII nerve occupied 8-10% of the total of intracerebral tumors and 70-80% of all cerebellous angle tumors. Microsurgery manifested good results for facial nerve function on 100% of small tumors, 40% of medium and 22.22% of large tumors. Functional hearing results were also evaluated with respect of the sizes of tumors. Complications of the surgery consisted mainly of cerebrospinal fluid leakage (2.12% of all patients). There were 8 cases of meningitis postoperatively, their 1 died. Complete resection of the tumor was accomplished on 63.8% of patients (consisting of 100% of small, 70% of medium and 61.1% of large tumors).
Microsurgery ; Neuroma, Acoustic ; neoplasms ; surgery

Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Neuroma, Acoustic ; pathology ; surgery

Hearing ; Humans ; Neuroma, Acoustic ; surgery ; Neurosurgical Procedures ; methods

PURPOSE: Tinnitus is a very common symptom of vestibular schwannoma, present in 45 to 80% of patients. We evaluated changes in tinnitus after translabyrinthine microsurgery (TLM) or gamma knife radiosurgery (GKS). MATERIALS AND METHODS: Among 78 patients with vestibular schwannoma who underwent TLM or GKS at Severance Hospital from 2009-2012, 46 patients with pre- or postoperative tinnitus who agreed to participate were enrolled. Pure tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS) scores for loudness, awareness, and annoyance were measured before and after treatment. Changes of THI and VAS were analysed and compared according to treatment modality, tumour volume, and preoperative residual hearing. RESULTS: In the TLM group (n=27), vestibulocochlear nerves were definitely cut. There was a higher rate of tinnitus improvement in TLM group (52%) than GKS group (16%, p=0.016). The GKS group had a significantly higher rate of tinnitus worsening (74%) than TLM group (11%, p<0.001). Mean scores of THI and VAS scores significantly decreased in the TLM group in contrast to significant increases in the GKS group. Tumor volume and preoperative hearing did not affect the changes in THI or VAS. CONCLUSION: GKS can save vestibulocochlear nerve continuity but may damage the cochlea, cochlear nerve and can cause worsening tinnitus. In cases where hearing preservation is not intended, microsurgery with vestibulocochlear neurectomy during tumor removal can sometimes relieve or prevent tinnitus.
Adult ; Female ; Humans ; Male ; Middle Aged ; Neuroma, Acoustic/*surgery ; Radiosurgery/*methods ; Tinnitus/*surgery ; Treatment Outcome

Ear, Inner ; surgery ; Humans ; Neuroma, Acoustic ; surgery ; Otologic Surgical Procedures ; methods

Neurofibromatosis type 2 (NF2) is a dominantly inherited genetic condition. Bilateral vestibular schwannoma, which are benign tumors, composed of neoplastic Schwann cells that arise from the eighth cranial nerve, are the hallmark of NF2. Standard approaches for treatment of growing vestibular schwannoma include observation, surgical removal and radiation therapy. Molecular targeted therapies also present great prosperity in recent years. In this review, we summarize the latest progresses on the treatment of NF2-associated vestibular schwannoma.
Humans ; Molecular Targeted Therapy ; Neurofibromatosis 2 ; radiotherapy ; surgery ; therapy ; Neuroma, Acoustic ; radiotherapy ; surgery ; therapy

OBJECTIVE: To explore application of endoscope assisting in retrosigmoid approach vestibular schwannoma resection and its signification. METHOD: Through retrosigmoid approach with endoscope assisting, vestibular schwannoma in the cerebellopontine angle was removed in 12 cases. Assessment of function of facial nerve and auditory was made for all patients preoperative and postoperative. RESULT: Vestibular schwannoma in 12 patients were removed completely, then the facial nerve and the acoustic nerve were preserved after tumor removal. No complication was found in six months. We observed the hearing loss in postoperative patients, and there is no difference in facial nerve function between preoperative and postoperative. The alteration of auditory and facial nerves functions is no difference between two retrosigmoid approach groups with or without endoscope assisting. CONCLUSION Application of endoscope assisting in retrosigmoid approach can be helpful for totally resection of vestibular schwannoma in inner acoustic meatus without lesion of canalis semicircularis and glomus jugulare. Application of the endoscope assisting in retrosigmoid approach is helpful to provide the precise information of CPA anatomic structure and decrease the incidence rate of complication.
Adult ; Aged ; Cerebellopontine Angle ; surgery ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Neuroma, Acoustic ; surgery

BACKGROUNDVestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation.

METHODSA retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed.

RESULTSTotal tumor resection was achieved in 140 cases (96.6%) and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% (132/145) of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients (Grade I and Grade II, 79.3%). No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is helpful for a safe drilling of the posterior wall of the internal acoustic meatus.

CONCLUSIONSThe goal of every surgery should be the preservation of function of all cranial nerves. Using the retrosigmoid approach with small craniotomy is possible even for large schwannomas. Knowing the microanatomy of the cerebellopontine angle and internal auditory meatus, intraoperating neurophysiological monitoring of the facial nerve function, and the microsurgical techniques of the surgeons are all important factors for improving total tumor removal and preserving facial nerve function.

Adult ; Craniotomy ; methods ; Facial Nerve ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroma, Acoustic ; surgery ; Retrospective Studies