Artikel
Video-assisted microsurgical treatment of vestibular schwannoma
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Veröffentlicht: | 19. April 2011 |
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Gliederung
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Video-assisted microsurgery represents modern trend of vestibular schwannoma (VS) treatment. Of the newly diagnosed 149 patients with VS 80 patients have undergone retrosigmoid microsurgical removal during 2007–2009. Video-assisted microsurgical (VA-MS) removal was performed in 37 cases (Koos grade I: 1, grade II: 6, grade III: 10, grade IV: 20) and microsurgical (MS) removal was performed in 43 cases (grade I: 1, grade II: 2, grade III: 7, grade IV: 33). The most common complication was CSF-epidural pseudocyst (35% in both groups) that was managed conservatively. Neither mortality nor infection occured. Despite all cases in MS group were deemed as radically removed among 8% of cases in VA-MS group we identified residual tumors intrameatally not observed by the microscope only and were radicalized. Furthermore potential CSF-leaks were identified in 2 patients with no postoperative CSF-leak in the VA-MS group (54% in the MS group). In the VA-MS group excellent or very good (House-Brackmann 1 or 2) facial nerve function was achieved in 97% while poor function (House-Brackmann ≥ 4) was observed in 3% postoperatively. In the MS group excellent or very good facial nerve function was achieved in 53%, good (House-Brackmann 3) in 28% and poor function in 2% postoperatively. Better cochlear nerve preservation rate (52 vs. 28%), hearing preservation (45 vs. 10%) and useful hearing preservation – AAO-HNS class A, B (53 vs. 17%) were achieved in the VA-MS group. Adjunctive use of endoscope during VS surgery seems promising for assessment of radicality of resection and to decrease incidence of postoparative complications. Improving the information about critical structures and tumor itself helps to improve facial nerve and hearing results.
Supported by: IGA MZ CR NS/9909–3