Current treatment strategy in the management of vestibular schwannoma|
Misra, Basant K.; Purandare, Harshad R.; Ved, Rahul S.; Bagdia, Anshul A. & Mare, Pandurang B.
Background: The changing trends in the management of vestibular schwannoma (VS) in our practice over the last two
decades as well as the current status are presented here. Materials and Methods: The observations are based on the experience of 559
consecutive cases of VS operated by the first author between 1987 and 2008, 438 of which were operated by microsurgery and 139 by gamma knife
radiosurgery (GKR) (18 of which were previously operated by the authors). A detailed analysis of microsurgically managed patients in two different
periods (100 consecutive patients each before 1993 and 2008) were compared to see the changing trend and document current results. Results
and Discussion: In the initial experience (1990s), the emphasis in microsurgery was preserving life, total excision of tumor and
preservation of function in that order. In the 21st century, the emphasis in microsurgery has been all about functional preservation.
In 100 consecutive cases of VS (excluding neurofibromatosis-2) that were treated microsurgically between 2005-08, there were four small tumors
(< 2 cm), 14 medium-sized tumors (2-3 cm) and 82 large tumors (≥3 cm). The total excision rate was 83%. The facial nerve
anatomical preservation rate was 96% and function was Grade III House-Brackmann (HB) or better in 87%. Both the total excision
rate and facial function of Grade II HB or better were 100% in cases with tumor size less than three cm. Functional hearing preservation
was achieved in ten cases. There was no operative mortality. Conclusion: Total excision of VS, though aimed at, is no more pursued at
the cost of facial function. Moreover, microsurgery, radiosurgery and observation are all valid options in the management of VS and choosing the
correct modality helps in achieving optimal outcome.
Acoustic neuroma, microsurgery, observation, radiosurgery, treatment