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Prof. Dr. med.
Abolghassem Sepehrnia

Topical publications

 

Vestibular schwannoma between 1 and 3 cm: Importance of thetumor size in surgical and functional outcome Arrow-Icon[PDF-Document]

Management of vestibular schwannoma between 1-3cm, importance of tumor size in clinical and functional outcome in 442 patients

 

Object

The authors evaluated the outcome of radical microsurgery via an osteoblastic retrosigmoid approach in a consecutive series of 442 patients with vestibular schwannomas (VSs) between 1-3cm out of our 1100 VSs.

Method

The authors performed a retrospective study of 257 patients with VSs between 1-2 cm in maximal intra/extrameatal diameter were included in this retrospective Study over a 5 year period (Group A). The group was compared with a matched group of 167 patients with VSs between 2-3 cm (Group B). Patient records, operative reports, follow-up data, and neuroradiological findings were analyzed. In all cases the retrosigmoid approach in semisitting position was performed. Outcome measures included completeness of tumor removal, facial nerve function, hearing function , and the surgery-related complication rate.

Results

The mean tumor size in Group A was 1.7 cm and in Group B was 2.6 cm. Total removal was achieved in all patients in two groups . The anatomical integrity of the facial nerve was preserved in 100 % of our study group A and 100 % of group B. At last follow- up 94% of the patients in group A had excellent (grade 1 H&B) and 6 % good facial nerve and in 51% of patients in group A preoperative hearing level preserved. Newly developed lower cranial nerve dysfunction occurred in 0% of patients . A CSF leak developed in 3 % of patients. Compared with Group B, a significant difference was found in the rates of the following parameters: excellent facial nerve function (H&B gradeI) (78% in group B) and preservation of preoperative hearing (34% in group B) (p < 0.05). The perioperative mortality rate in both group was 0% and surgery related complication rate was the same in two groups.

Conclusions

The goal of VS treatment should be total removal in one stage and preservation of neurological function, as they mainly determine a patient’s quality of life. This goal can be safely and much more successfully achieved using the retrosigmoid approach while tumor size is between 1-2 cm . In patients with the tumor size between 1-2 cm in comparison with the patients with the tumor size between 2-3 cm, total tumor removal can be achieved with low morbidity rate, especially with regards to facial nerve and Hearing excellent function preservation. Any changes in tumor size even in the small tumors significantly correlates with postoperative outcome of facial and hearing preservation.

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Management of Vestibular Schwannoma - Non-Cystic vs Cystic- Functional outcome

 

Abstract

The passed published literature concerning postoperative results of cystic vestibular schwannoma show no clear results.
In our work we compare the outcome of the function of the facial nerve and the hearing function in cystic vestibular schwannoma versus non-cystic vestibular schwannoma after total resection by a lateral subocciptal approach.

Study

1000 vestibular schwannoma have been operated by Prof. A.S. The sampled data due to clinical notes, audiogram, MRI, surgery reports, discharge letters, histology, follow-up notes and pre-and postoperative facial nerve and hearing test.

We analyzed the data retrospectively. Exclusion criteria have been patients with NF-2, recurrent tumours and recurrence after Gammaknife treatment.
All patients received transesophageal echocardiography to exclude a persistent foramen ovale to be operated in semi-sitting position. Facial nerve test and hearing function have been examined pre-and postoperatively. The used classification is the House-Brackmann and Gardner Robertson classification.
The operated patients received one day postoperatively MRI for resection control or to detect bleedings.

54% were female patients. The average age was higher in the female (46,7yrs) than male (44,2 yrs) group of patients.
In our study patients with radiologically proved cystic tumor parts and confirmed by the surgeon within the surgery have been defined as doubtless cystic.
11% have been cystic vestibular schwannoma.
21, 6% of had a persistent foramen ovale.

No air embolisation, one patient suffered from Pneumocephalon. Here extubation phase prolonged, without respiratory deficits.
The rest of the patients have been extubated in the operation theatre. In all operations neurophysiologic monitoring was applied.

The good function of the facial nerve was classified as sum of H&B I and II compared within cystic (c) versus non-cystic (nc) acoustic neurinoma. The results are: 1-2cm 95% v 97, in 2-3cm 90%-94% in 3-4cm 80%-82%.
The hearing function classified in Gardner & Robertson I and II,(III) show in the postoperative results: 1-2cm 53% v 51%, 2-3cm 36% v 33% and 3-4cm 26% v 28%. Our results show no explicit and significant differences in both groups.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contactadress

Switzerland

My Medical practise is in the hospital:

Hirslanden | Klinikzentren – Klinik St. Anna

Prof. Dr. med. Sepehrnia
Schädelbasischirurgische
Klinik St. Anna
Hirslanden Klinik St. Anna
Ärztehaus Lützelmatt (Trakt L)
St. Anna-Strasse 32
CH-6006 Luzern

Tel +41 (0)41 918 0000
Fax +41 (0)41 918 0001
sekr.sepehrnia[at]hirslanden.ch

More about the Hospital St. Anna: Klinik St Anna

 

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