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The first 50s: can we achieve acceptable results in vestibular schwannoma surgery from the beginning?

  • Clinical Article
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Abstract

Objective

Vestibular schwannoma surgery requires a profound knowledge of anatomy and long-standing experience of surgical skull base techniques, as patients nowadays requests high-quality results from any surgeon. This educes a dilemma for the young neurosurgeon as she/he is at the beginning of a learning curve. The presented series should prove if surgical results of young skull base surgeons are comparable respecting carefully planned educational steps.

Methods

The first 50 vestibular schwannomas of the first author were retrospectively evaluated concerning morbidity and mortality with an emphasis on functional cranial nerve preservation. The results were embedded in a timeline of educational steps starting with the internship in 1999.

Results

Fifty vestibular schwannomas were consecutively operated from July 2007 to January 2010. According to the Hannover Classification, 14% were rated as T1, 18% as T2, 46% as T3, and 21% as T4. The overall facial nerve preservation rate was 96%. Seventy-nine percent of patients with T1–T3 tumours had no facial palsy at all and 15% had an excellent recovery of an initial palsy grade 3 according to the House & Brackman scale within the first 3 months after surgery. Hearing preservation in T1/2 schwannomas was achieved in 66%, in patients with T3 tumours in 56%, and in large T4 tumours in 25%. Three patients suffered a cerebrospinal fluid fistula (6%), and one patient died during the perioperative period due to cardiopulmonary problems (2%).

Conclusions

The results demonstrate that with careful established educational plans in skull base surgery, excellent clinical and functional results can be achieved even by young neurosurgeons.

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References

  1. Brennum J (2000) European neurosurgical education—the next generation. Acta Neurochir (Wien) 142:1081–1087

    Article  CAS  Google Scholar 

  2. Briggs RJ, Fabinyi G, Kaye AH (2000) Current management of acoustic neuromas: review of surgical approaches and outcomes. J Clin Neurosci 7:521–526

    Article  PubMed  CAS  Google Scholar 

  3. Buchman CA, Chen DA, Flannagan P, Wilberger JE, Maroon JC (1996) The learning curve for acoustic tumor surgery. Laryngoscope 106:1406–1411

    Article  PubMed  CAS  Google Scholar 

  4. Cohen-Gadol AA, Piepgras DG, Krishnamurthy S, Fessler RD (2005) Resident duty hours reform: results of a national survey of the program directors and residents in neurosurgery training programs. Neurosurgery 56:398–403, discussion 398-403

    Article  PubMed  Google Scholar 

  5. Ebner FH, Dimostheni A, Tatagiba MS, Roser F (2010) Step-by-step education of the retrosigmoid approach leads to low approach-related morbidity through young residents. Acta Neurochir (Wien). doi:10.1007/s00701-010-0611-z

  6. Elsmore AJ, Mendoza ND (2002) The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach. Br J Neurosurg 16:448–455

    Article  PubMed  CAS  Google Scholar 

  7. Eroes CA, Barth C, Tonn JC, Reulen HJ (2008) The revised European neurosurgical electronic logbook of operations. Acta Neurochir (Wien) 150:195–198

    Article  CAS  Google Scholar 

  8. Fukuda M, Oishi M, Takao T, Saito A, Fujii Y (2008) Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome. J Neurol Neurosurg Psychiatry 79:1066–1070

    Article  PubMed  CAS  Google Scholar 

  9. Gharabaghi A, Acioly MA, Koerbel A, Tatagiba M (2007) Prognostic factors for hearing loss following the trigeminocardiac reflex. Acta Neurochir (Wien) 149:737, author reply 737–738

    Article  CAS  Google Scholar 

  10. Gharabaghi A, Koerbel A, Lowenheim H, Kaminsky J, Samii M, Tatagiba M (2006) The impact of petrosal vein preservation on postoperative auditory function in surgery of petrous apex meningiomas. Neurosurgery 59:ONS68–ONS74, discussion ONS68-74

    PubMed  Google Scholar 

  11. Grady MS, Batjer HH, Dacey RG (2009) Resident duty hour regulation and patient safety: establishing a balance between concerns about resident fatigue and adequate training in neurosurgery. J Neurosurg 110:828–836

    Article  PubMed  Google Scholar 

  12. Graham MD (1984) Residency and fellowship training in otology, neurotology, and skull base surgery within an academic department of otolaryngology. Am J Otol 5:229–232

    PubMed  CAS  Google Scholar 

  13. Hoff JT (2003) Quality control in neurosurgery training. Acta Neurochir (Wien) 145:735–736

    Article  CAS  Google Scholar 

  14. House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147

    PubMed  CAS  Google Scholar 

  15. Lanman TH, Brackmann DE, Hitselberger WE, Subin B (1999) Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. J Neurosurg 90:617–623

    Article  PubMed  CAS  Google Scholar 

  16. Lindsay KW (2002) Neurosurgical training in the United Kingdom and Ireland: assessing progress and attainment. Neurosurgery 50:1103–1111, discussion 1111-1103

    PubMed  Google Scholar 

  17. Marouf R, Noudel R, Roche PH (2008) Facial nerve outcome after microsurgical resection of vestibular schwannoma. Prog Neurol Surg 21:103–107

    Article  PubMed  Google Scholar 

  18. Moffat DA, Hardy DG, Grey PL, Baguley DM (1996) The operative learning curve and its effect on facial nerve outcome in vestibular schwannoma surgery. Am J Otol 17:643–647

    PubMed  CAS  Google Scholar 

  19. Ojemann RG (1993) Management of acoustic neuromas (vestibular schwannomas) (honored guest presentation). Clin Neurosurg 40:498–535

    PubMed  CAS  Google Scholar 

  20. Reulen HJ (2004) The accreditation of a training programme. Acta Neurochir Suppl 90:103–106

    PubMed  CAS  Google Scholar 

  21. Reulen HJ, Marz U (1998) 5 years’ experience with a structured operative training programme for neurosurgical residents. Acta Neurochir (Wien) 140:1197–1203

    Article  CAS  Google Scholar 

  22. Samii M, Gerganov V, Samii A (2006) Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 105:527–535

    Article  PubMed  Google Scholar 

  23. Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 40:248–260, discussion 260-242

    Article  PubMed  CAS  Google Scholar 

  24. Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–21, discussion 21–13

    PubMed  CAS  Google Scholar 

  25. Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve—preservation and restitution of function. Neurosurgery 40:684–694, discussion 694–685

    Article  PubMed  CAS  Google Scholar 

  26. Sampath P, Rini D, Long DM (2000) Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases. J Neurosurg 92:70–78

    Article  PubMed  CAS  Google Scholar 

  27. Sharp MC, MacfArlane R, Hardy DG, Jones SE, Baguley DM, Moffat DA (2005) Team working to improve outcome in vestibular schwannoma surgery. Br J Neurosurg 19:122–127

    Article  PubMed  CAS  Google Scholar 

  28. Stranjalis G (1996) The overprotection of neurosurgeons jeopardizes future neurosurgical care. Surg Neurol 45:314–319

    Article  PubMed  CAS  Google Scholar 

  29. Strauss C, Bischoff B, Neu M, Berg M, Fahlbusch R, Romstock J (2001) Vasoactive treatment for hearing preservation in acoustic neuroma surgery. J Neurosurg 95:771–777

    Article  PubMed  CAS  Google Scholar 

  30. Strauss C, Romstock J, Fahlbusch R, Rampp S, Scheller C (2006) Preservation of facial nerve function after postoperative vasoactive treatment in vestibular schwannoma surgery. Neurosurgery 59:577–584, discussion 577–584

    Article  PubMed  Google Scholar 

  31. Tatagiba M, Matthies C, Samii M (1996) Microendoscopy of the internal auditory canal in vestibular schwannoma surgery. Neurosurgery 38:737–740

    Article  PubMed  CAS  Google Scholar 

  32. Tatagiba M, Samii M, Matthies C, el Azm M, Schonmayr R (1992) The significance for postoperative hearing of preserving the labyrinth in acoustic neurinoma surgery. J Neurosurg 77:677–684

    Article  PubMed  CAS  Google Scholar 

  33. Welling DB, Slater PW, Thomas RD, McGregor JM, Goodman JE (1999) The learning curve in vestibular schwannoma surgery. Am J Otol 20:644–648

    PubMed  CAS  Google Scholar 

  34. Yasargil MG (1996) Management of acoustic neuromas. Microneurosurgery, vol. IVB. Thieme, New York, pp. 100–123

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Acknowledgments

This paper is dedicated to Prof. Tatagiba (Tübingen/Germany) and Prof. Samii (Hannover/Germany). Without their continuous support and their believe in my workforce, it would never have been possible to publish these results. We are grateful to Gerd Pfister for creating the Figure 1.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany

    Florian Roser & Marcos S. Tatagiba

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  1. Florian Roser
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  2. Marcos S. Tatagiba
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Correspondence to Florian Roser.

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Roser, F., Tatagiba, M.S. The first 50s: can we achieve acceptable results in vestibular schwannoma surgery from the beginning?. Acta Neurochir 152, 1359–1365 (2010). https://doi.org/10.1007/s00701-010-0672-z

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  • DOI: https://doi.org/10.1007/s00701-010-0672-z

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