Middle Fossa Approach for Resection of Vestibular Schwannomas: A Decade of Experience.
Action Potentials
Adult
Audiometry, Pure-Tone
Cochlear Nerve
Cohort Studies
Correction of Hearing Impairment
Cranial Fossa, Middle
Evoked Potentials, Auditory, Brain Stem
Female
Hearing Loss
/ epidemiology
Humans
Intraoperative Neurophysiological Monitoring
/ methods
Male
Microsurgery
/ methods
Middle Aged
Neuroma, Acoustic
/ physiopathology
Neurosurgical Procedures
/ methods
Postoperative Complications
/ epidemiology
Retrospective Studies
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 02 2019
01 02 2019
Historique:
received:
06
09
2017
accepted:
26
04
2018
pubmed:
12
6
2018
medline:
30
7
2020
entrez:
12
6
2018
Statut:
ppublish
Résumé
The middle cranial fossa (MCF) approach is a challenging surgical technique for the resection of small and intermediate sized, primarily intracanalicular, vestibular schwannomas (VS), with the goal of hearing preservation (HP). To describe a decade-long, single institutional experience with the MCF approach for resection of VS. This is a retrospective cohort study of 63 patients who underwent the MCF approach for resection of VS from 2006 to 2016. Audiometric data included pure-tone average (PTA), low-tone pure-tone average (LtPTA), word recognition score, and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification at presentation and follow-up. Patients with postoperative serviceable (AAO-HNS class A-B) and/or useful (AAO-HNS class A-C) hearing were compared to those without HP. Facial nerve function was assessed using the House-Brackmann scale. The mean age and duration of follow-up were 50 ± 13 yr and 21 ± 21 mo, respectively. The mean tumor size was 10 ± 4 mm. The serviceable and usable HP rates were 54% and 50%, respectively. Some residual hearing was preserved in 71% of patients. Large tumor size (P = .05), volume (P = .03), and extrameatal tumor extension (P = .03) were associated with poor audiometric outcomes. The presence of a fundal fluid cap (P = .01) was a favorable finding. At definitive testing, LtPTA was significantly better preserved than traditional PTA (P = .01). Facial nerve outcomes, tumor control rates, and durability of audiometric outcomes were excellent. 47% of patients pursued aural rehabilitation. In our series, the MCF approach for VS provided excellent rates of tumor and facial nerve function, with durable serviceable HP.
Sections du résumé
BACKGROUND
The middle cranial fossa (MCF) approach is a challenging surgical technique for the resection of small and intermediate sized, primarily intracanalicular, vestibular schwannomas (VS), with the goal of hearing preservation (HP).
OBJECTIVE
To describe a decade-long, single institutional experience with the MCF approach for resection of VS.
METHODS
This is a retrospective cohort study of 63 patients who underwent the MCF approach for resection of VS from 2006 to 2016. Audiometric data included pure-tone average (PTA), low-tone pure-tone average (LtPTA), word recognition score, and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification at presentation and follow-up. Patients with postoperative serviceable (AAO-HNS class A-B) and/or useful (AAO-HNS class A-C) hearing were compared to those without HP. Facial nerve function was assessed using the House-Brackmann scale.
RESULTS
The mean age and duration of follow-up were 50 ± 13 yr and 21 ± 21 mo, respectively. The mean tumor size was 10 ± 4 mm. The serviceable and usable HP rates were 54% and 50%, respectively. Some residual hearing was preserved in 71% of patients. Large tumor size (P = .05), volume (P = .03), and extrameatal tumor extension (P = .03) were associated with poor audiometric outcomes. The presence of a fundal fluid cap (P = .01) was a favorable finding. At definitive testing, LtPTA was significantly better preserved than traditional PTA (P = .01). Facial nerve outcomes, tumor control rates, and durability of audiometric outcomes were excellent. 47% of patients pursued aural rehabilitation.
CONCLUSION
In our series, the MCF approach for VS provided excellent rates of tumor and facial nerve function, with durable serviceable HP.
Identifiants
pubmed: 29889286
pii: 5034818
doi: 10.1093/ons/opy126
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM