Acoustic neuroma – vestibular schwannoma – personal experience of up-to-date management
Authors:
Eduard Zvěřina 1,2
Authors‘ workplace:
Univerzita Karlova v Praze, 1. lékařská fakulta, Klinika ORL a chirurgie hlavy a krku FNM 2Univerzita Karlova v Praze, 3. lékařská fakulta, Neurochirurgická klinika FNKV
1
Published in:
Čas. Lék. čes. 2010; 149: 269-276
Category:
Review Article
Overview
Acoustic neuroma, properly called vestibular schwannoma, arises from the Schwann cells of the vestibular transitional zone of the vestibulocochlear nerve as the most frequent tumour of the posterior fossa. Its incidence is estimated at 1.2 vestibular schwannoma per a population of 100 000/year. As to size, vestibular schwannoma is classified into grades I to IV. Its benign variety threatens the patient with hearing and balance impairment; uncontrolled growth can lead to death. About one third of small vestibular schwannoma show hardly any growth, the larger ones grow aggressively. The author’s conclusion is based on 33 years of experience with hundreds of surgically treated vestibular schwannoma (now at the ENT Department of Head and Neck Surgery, CU 1st Medical Faculty and FN Teaching Hospital, Prague Motol). Three different therapeutic strategies are currently used: 1. Wait and rescan – close follow-up with regular MRI and hearing tests. Growing tumours require active intervention. 2. Stereoradio-surgery using the Leksell gamma knife is a suitable option for small tumours (grades I and II). Irradiation for larger vestibular schwannoma is decreasingly efficacious. 3. Microsurgery with intraoperative monitoring of facial and acoustic nerve function offers scope for radical removal of vestibular schwannoma of any size (grades I–IV) and for the preservation of facial nerve function and, of late, hearing, too. The larger the tumour, the more difficult it is. The demanding nature of microsurgery requires the patients’ concentration in special centres with neurosurgical and ENT cooperation. The worst results are achieved with only a partial resection and follow-up stereoradiosurgical treatment. Secondary microsurgery can hardly prevent the patient’s disability.
Key words:
acoustic neuroma, vestibular schwannoma, microneurosurgery, streoradiosurgery, Leksell gamma knife, facial nerve, vestibulocochlear nerve.
Sources
1. Kunc Z. Neurochirurgie, 3. vydání. Praha: Avicenum 1983.
2. Stejskal L, et al. Evokované odpovědi a jejich klinické využití. Praha: Praha-Publishing 1993.
3. Škorpil V. Vztah ztráty nepřímé svalové dráždivosti a nástupu denervačních fibrilací po přerušení n. facialis. Česk Neurol 1963; 26: 307–310.
4. Škorpil V, Zvěřina E. Metoda EMG hodnocení periferních a centrálních mechanismů úpravy hybnosti při anastomóze n. VII a n. XII. Česk Neurol 1963; 26: 317–320.
5. Urgošík D, Živný B, Zvěřina E, Fusek I, Stejskal L, Plas J. Elektrofyziologické sledování funkce n. VII při operacích neurinomu n. VIII. Čes a Slov Neurol Neurochir 1994; 57: 17–21.
6. Zvěřina E, Stejskal L. Poranění periferních nervů. Praha: Avicenum 1979.
7. Zvěřina E, Fusek I, Kunc Z, Sobota J, Stejskal L. První zkušenosti s mikrochirurgií nádorů n. VIII. Čes a Slov Neurol Neurochir 1983; 46: 287–292.
8. Betka J, Zvěřina E, Lisý J, Chovanec M. Vestibulární schwannom. Otorinolaryng a Foniatr (Prague) 2008; 4: 221–225.
9. Betka J, Zvěřina E, Chovanec M, Kluh J, Lukeš P, Kraus J, Lisý J. Minimální invazivní endoskopicky asistovaná chirurgie vestibulárního schwannomu. Endoskopie 2009; 18: 67–71.
10. Skřivan J, Zvěřina E, Betka J, Kluh J, Kraus J. Our surgical experience with large vestibular schwannomas. Otolaryngol Pol 2004; 58: 69–72.
11. Šmilauer T, Kluh J, Zvěřina E, Betka J. Přínos BERA k diagnostice neurinomu akustiku. Otorinolaryng a Foniatr (Prague) 2001; 50: 99–102.
12. Zveřina E, Betka J, Skřivan J, Kluh J, Kraus J, Lisý J, Belšan T. Vestibular schwannomas, preferable treatment. In: International Proceedings. 13th World Congress of Neurological Surgery. Bologna: Medimond S.r.l. 2005; 267–271.
13. Samii M, Draf W. Surgery of the Skull Base. An Interdisciplinary Approach. Berlin: Springer-Verlag 1989.
14. Sameš M, Vachata P. Historie a současnost chirurgie baze lební. Čes a Slov Neurol Neurochir 2003; 66: 315–322.
15. Koos WT, Spetzler RF, Pendl G, Pernetzky A, Lang J. Color Atlas of Microsurgery. Stuttgart: Georg Thieme 1985.
16. Nemeček S, Pařízek J, Špaček J, Němečková J. Histological, histochemical and ultrastructural appearence of the transitional zone of the cranial and spinal nerve root. Folia Morphologica 1969; 17: 171–181.
17. Matthies C, Samii M. Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for intraoperative monitoring of auditory function in 200 cases. Neurosurgery 1997; 40: 459–466.
18. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 1997; 40: 248–260.
19. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997; 40: 11–21.
20. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve-preservation and restitution of function. Neurosurgery 1997; 40: 684–694.
21. Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 2006; 105: 527–535.
22. Gharabaghi A, Samii A, Koerbel A, Rosahl SK, Tatagiba M, Samii M. Preservation of function in vestibular schwannoma surgery. Neurosurgery 2007; 60: 124–127.
23. Kanzaki J, Tos M, Sanna M, Moffat DA. New and modified reporting systems from the Consensus Meeting on System for Reporting Results in Vestibular Schwannoma. Otol Neurotol 2003; 24: 642–649.
24. Doherty JK, riedman RA. Controversies in building a management algorithm for vestibular schwannomas. Curr Opin Otolaryngol Head Neck Surg 006; 14: 305–313.
25. Myrseth E, Pedersen PH, MŅller P, Lund-Johansen M. Treatment of vestibular schwannomas. Why, when and how? Acta Neurochir (Wien) 2007; 149: 647–660.
26. Thomsen J, Tos M. Acoustic neuroma: clinical aspects, audiovestibular assesment, diagnostic delay, and growth rate. Am J Otol 1990; 11: 12–19.
27. Koerbel A, Gharabaghi A, Safari-Abbasi S, Tatagiba M, Samii M. Evolution of vestibular schwannoma surgery: the long journey to current soccess. Neurosurg Focus 2005; 18: 1–6.
28. Liščák R, et al. Radiochirurgie gama nožem. Principy a neurochirurgické aplikace. Praha: Grada Publishing 2009.
29. Pollock BE, Lunsford LD, Norén G. Vestibular Schwannoma management in the next century: a radiosurgical perspective. Neurosurgery 1998; 43: 475–483.
30. Wackym PA. Stereotactic radiosurgery, microsurgery, and expectant management of acoustic neuroma: basis for informed consent. Otolaryngol Clin North Am 2005; 38: 653–670.
31. Dandy WE. The Brain. Hagerstown: WF Prior Copany 1966.
32. Yasargil M G, Fox JL. The microsurgical approach to acoustic neurinomas. Surg Neurol 1974; 2: 393–398.
33. Skřivan J, Zvěřina E, Betka J, Světlík J, Sollmann WP, Tichý T, Sedlák S, Topol M, Urgošík D, Mazanec R, Nevison B, Morrisová P. Sluchová kmenová neuroprotéza z pohledu otolaryngologa (První vlastní zkušenosti). Otolaryng a Foniatr (Prague) 1999; 48: 203–206.
34. Zvěřina E, Sollmann WP, Betka J, Skřivan J, Tichý T, Nevison B, Urgošík D. The First Auditory Brainstem Implant (ABI) in Czech Republic. Adv Clin Exp Med 2000; 9(Suppl. 1): 29–31.
35. Zveřina E, Sollmann W P, Betka J, Skřivan J, Tichý T, Nevison B, Urgošík D. First auditory brainstem implant in Czech Rebublic. J Laryngol Otol Suppl 2000; 54–55.
36. Skřivan J, Zvěřina E, Betka J, Světlík M, Kluh J, Sollmann WP, Kraus J, Belšan T, Tichý T, Sedlák S, Topol M. Sluchová kmenová neuroprotéza v České republice. Čas Lék čes 2003; 142: 29–33.
37. Zveřina E, Skřivan J, Betka J, Kraus J, Belšan T, Sollmann WP. Minimally invasive surgery. Large vestibular schwannomas and auditory brainstem implant. In: Proceedings of the 3td International Mt.Bandai Symposium for Neuroscience and 4th Pan-Pacific Neurosurgery Congress. Amsterdam: Elsevier B. V. 2004; 75–79.
38. Zvěřina E, Betka J, Skřivan J. Vestibular Schwannoma: Misrosurgery after Partial Removal and Steroradiosurgery. In: 7th European Skull Base Society Congress – Presentation abstracts. Fulda: Skull Base. Thieme 2005; 6.
39. Zveřina E, Betka J, Skřivan J, Kluh J, Chovanec M, Kraus J. Difficulty of microsurgical treatment of vestibular schwannoma after failure of steroradiosurgery. 5th International Conference on Vestibular Schwannoma and Other CPA Lesions. Bologna: Medimond S.r.l. 2007; 349–354.
40. Draf W, Samii M. Intracranial-intratemporal anastomosis of the facial nerve. aryngol Rhinol Otol (Stuttg) 1980; 59: 282–287.
41. Dott NM. Facial paralysis; restitution by extrapetrous nerve graft. Proc R Soc Med 1958; 51: 900–902.
42. Darrouzet V, Guerin J, Bébéar JP. Technique of side-to-end hypoglossal-facial nerve attachment with translocation of the intratemporal facial nerve. J Neurosurg 1999; 90: 27–34.
43. Ebner FH, Dimostheni A, Tatagiba MS, Roser F. Step-by-step education of the retrosigmoid approach leads to low approach-related morbidity through young residents. Acta Neurochir (Wien) 2010 (Epub ahead of print).
44. Liščak R, Vladyka V, Urgošík D, Simonová G, Vymazal J. Repeated treatment of vestibular schwannomas after gamma knife radiosurgery. Acta Neurochir (Wien) 2009; 151: 317–324.
45. Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas. Surg Neurol 2003; 59: 283–289.
46. Pollock BE, unsford LD, lickinger JC, lyde BL, ondziolka D. Vestibular schwannoma management. Part I. Failed microsurgery and the role of delayed stereotactic radiosurgery. J Neurosurg 1998; 89: 944–948.
47. Friedman RA, Brackmann DE, Hitselberger WE, Schwartz MS, Iqbal Z, Berliner KI. Surgical salvage after failed irradiation for vestibular schwannoma. Laryngoscope 2005; 115: 1827–1832.
48. Roche PH, Khalil M, Thomassin JM, Delsanti C, Régis J. Surgical removal of vestibular schwannoma after failed gamma knife radiosurgery. Prog Neurol Surg 2008; 21: 152–157.
49. Roche PH, Khalil M, Soumare O, Régis J. Hydrocephalus and vestibular schwannomas: considerations about the impact of gamma knife radiosurgery. Prog Neurol Surg 2008; 21: 200–206.
50. Lee DJ, Westra WH, Staecker H, Long D, Niparko JK, Slattery WH 3rd. Clinical and histopathologic features of recurrent vestibular schwannoma (acoustic neuroma) after stereotactic radiosurgery. Otol Neurotol 2003; 24: 650–660.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
Most read in this issue
- Acoustic neuroma – vestibular schwannoma – personal experience of up-to-date management
- Calcitonin and his role in regulation of calcium-phosphate metabolism
- Beta-blockers in flow of time – view of an anaesthesiologist and intensivist
- Type 2 diabetes mellitus as a subclinical inflammation