• The Translabyrinthine Approach for Treating Vestibular Schwannoma - Long-term Surgical Outcomes of 332 Patients

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    Eric Goulin Lippi Fernandes MD; Nikita Bos MD; Maarten C. Kleijwegt MD; J.C. Jansen MD, PhD; Martijn JA Malessy MD, PhD; Andel van der Mey MD, PhD; Radboud Koot MD, PhD

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    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The most important issues in the treatment of vestibular Schwannoma are long-term tumor control and facial nerve function. In the Leiden University Medical Center, we choose to treat vestibular Schwannoma patients with resection by the translabyrinthine approach with the intention of a (near) total resection. To evaluate this policy, we studied the 5-year tumor control rate and the long-term facial nerve outcome of patients operated in a 10-year period by the same team of 2 neurosurgeons and 2 otolaryngologists.

    Methods: We retrospectively reviewed the medical records of patients treated for vestibular Schwannoma by the translabyrinthine approach in the 10-year period of January 2005 through December 2014. Exclusion criteria: prior surgery or radiotherapy in the cerebellopontine angle (n=12), neurofibromatosis type 2 (n=5), pathology other than vestibular Schwannoma (n=17) and follow-up less than 1 year (n=46). We analyzed the preoperative tumor size, 5-year tumor recurrence rate and 1-year facial nerve outcome (good=House Brackman I-II; adverse= House Brackman III-VI) of these patients.

    Results: We included 332 patients in this study; 163 had >5 years follow-up. Of the total group, 34% had small tumors (<1.5cm), 34% had medium-size tumors (between 1.5 and 2.5cm) and 32% had large tumors (>2.5cm). Intraoperatively, the facial nerve was anatomically and physiologically intact in 93% of patients. The 1-year postoperative facial nerve outcomes were good for 87% of small tumors, 89% of medium sized tumors and 75% of large tumors. Overall 5-year recurrence rate was 11.7% (n=19). Of these, 8 received stereotactic radiation therapy, 3 were re-operated and 8 showed stabilized tumor size and have a ‘wait and scan’ policy.

    Conclusions: The translabyrinthine approach is an effective treatment for vestibular Schwannoma for long-term tumor control, and a large portion of patients have a good long-term facial nerve outcome. These results should be weighed against the potential benefits of other treatment strategies.

    Patient Care: This study is one of the few and largest single center studies that concerns the postoperative outcome of patients who received resection of vestibular Schwannoma by the translabyrinthine. After its conclusion and publication, this study will serve as an important tool in the decision-making process for patients with vestibular Schwannomas, as it will demonstrate the potential benefits and demerits of this treatment and lend itself for comparison with other treatment options. Patients and health care professionals will be better able to make a better informed decision.

    Learning Objectives: -Discuss the facial nerve outcome after the translabyrinthine resection of vestibular Schwannomas -Discuss the rate of complete curation of vestibular Schwannomas of all sizes


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