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Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery: a technical feasibility study

  • Original Article - Tumor - Schwannoma
  • Published:
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Abstract

Background

Management of small vestibular schwannomas (VSs) remains controversial. When surgery is chosen, the preservation of facial and cochlear nerve function is a priority. In this report, we introduce and evaluate a technique to anatomically preserve the vestibular nerves to minimize manipulation and preserve the function of the facial and cochlear nerves.

Methods

The vestibular nerve preservation technique was prospectively applied to resect small VS tumors in patients with serviceable preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B). Clinical and radiological data were recorded and analyzed.

Results

Ten patients met the inclusion criteria. The mean (SD) age was 40.4 (12.5) years. Follow-up ranged from 6 weeks to 2 years. The maximum tumor diameter parallel to the internal auditory canal ranged from 10 to 20 mm (mean, 14.9 (3.1) mm). There were three Koos grade 3 and seven Koos grade 2 tumors. Gross total resection was achieved in all cases. Both the facial and cochlear nerves were anatomically preserved in all cases. Postoperatively, 7 patients (70%) remained in the AAO-HNS class A or B hearing category. None of the patients had new vestibular symptoms, and all had House–Brackmann grade 1 facial function. Nervus intermedius dysfunction was observed in 1 patient preoperatively, which worsened postoperatively. Two patients had new nervus intermedius symptoms postoperatively.

Conclusion

Improvement of facial nerve and hearing outcomes is feasible through the intentional preservation of the vestibular nerves in the resection of small VSs. Longer follow-up is required to rule out tumor recurrence.

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Abbreviations

AAO-HNS:

American Academy of Otolaryngology-Head and Neck Surgery

CPA:

Cerebellopontine angle

HB:

House–Brackmann

VS:

Vestibular schwannoma

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Acknowledgments

The authors thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript and video preparation.

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Authors and Affiliations

  1. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA

    Mohamed A. Labib & Michael T. Lawton

  2. Department of Neurosurgery, University of Colorado, CO, Aurora, USA

    Mizuho Inoue & A. Samy Youssef

  3. Department of Otolaryngology, University of Colorado, CO, Aurora, USA

    Renee M. Banakis Hartl, Stephen Cass, Samuel Gubbels & A. Samy Youssef

Authors
  1. Mohamed A. Labib
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  2. Mizuho Inoue
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  3. Renee M. Banakis Hartl
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  4. Stephen Cass
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  5. Samuel Gubbels
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  6. Michael T. Lawton
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  7. A. Samy Youssef
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MAL, MI, and ASY. The first draft of the manuscript was written by MAL, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to A. Samy Youssef.

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Conflict of interest

A. Samy Youssef is a consultant for Stryker Corp. and receives royalties from Mizuho America, Inc.

Ethical approval

This is an observational study. The Research Ethics Committee at the University of Colorado has confirmed that no ethical approval is required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Labib, M.A., Inoue, M., Banakis Hartl, R.M. et al. Impact of vestibular nerve preservation on facial and hearing outcomes in small vestibular schwannoma surgery: a technical feasibility study. Acta Neurochir 163, 2219–2224 (2021). https://doi.org/10.1007/s00701-020-04678-y

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  • DOI: https://doi.org/10.1007/s00701-020-04678-y

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