Microsurgery Results in Vestibular Schwannoma Patients: Retrospective Clinical Study

Objective: Nowadays due to developing imaging techniques, vestibular schwannoma cases are monitored more frequently. In this study, the results of the patients who underwent surgery in the Department of Neurosurgery, Istanbul University Istanbul School of Medicine were retrospectively evaluated. Methods: Radiological and clinical findings of 18 patients with vestibular schwannoma diagnosed in our clinic from 2012 to 2017 were evaluated. After describing the possible treatment methods of the disease in detail, oral and written informed consent was obtained from all of them. Results: In our study, 18 patients, consisting of 13 women and 5 males, were examined. Eleven patients were found with a mass diameter below 3 cm, and seven patients were found with mass diameter above 3 cm. All patients underwent mass resection with retrosigmoid craniotomy. Total resection was performed in 11 patients, and subtotal resection was done in 7 patients. In seven patients with total resection (63.6%), a newly developed facial paresis was observed. The newly developed glossopharyngeal nerve paresis was observed in three patients (27.2%), and also abducens nerve paresis in three patients (27.2%). The facial nerve was preserved at a rate of 42% in tumors larger than 3 cm in size. The CSF fistula developed in one patient (5.5%); hydrocephalus developed in one patient (5.5%). Conclusion: In cases of vestibular schwannoma, microsurgery, radiosurgery, and wait/follow approaches are monitored. Although gold is standard microsurgery in tumors sized above 3 cm, the treatment plan for tumors under 3 cm in size is controversial. In this study, postoperative facial paresis was developed in all patients with total resection, which were below the mass size of 3 cm. The fact that the abducens and glossopharyngeal nerve paresis in patients with total resection have been seen less frequently in patients with subtotal resection is a factor that can affect the decision of total-subtotal resection. Therefore, the treatment plan should be taken into consideration (total resection/subtotal resection + radiosurgery) considering the existing neuromonitoring facilities in tumors larger than 3 cm in size.