open access

Vol 49, No 5 (2015)
Original research articles
Submitted: 2015-05-10
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Strategy for the surgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Arkadiusz Nowak, Tomasz Dziedzic, Tomasz Czernicki, Przemysław Kunert, Krzysztof Morawski, Kazimierz Niemczyk, Andrzej Marchel
DOI: 10.1016/j.pjnns.2015.06.008
·
Neurol Neurochir Pol 2015;49(5):295-301.

open access

Vol 49, No 5 (2015)
Original research articles
Submitted: 2015-05-10

Abstract

Objective

Guidelines for appropriate management of vestibular schwannomas in NF2 patients are controversial. In this paper we reviewed our experience with patients with NF2 for the results of surgical treatment with particular reference to hearing and facial nerve preservation.

Methods

We included in the study 30 patients (16 women and 14 men) with the diagnosis of NF2 treated in our department between 1998 and 2014 who underwent surgery for vestibular schwannoma removal with a follow-up for at least 1 year. In 3 cases, the vestibular schwannomas were unilateral. Six patients with bilateral vestibular schwannomas underwent unilateral procedure. Therefore, 51 acoustic tumors were studied in 30 patients.

Results

No operative death we noted. Significant deterioration to the non-functional level occurred in 19 out of 22 cases with well-preserved preoperative hearing. Only three ears maintained their preoperative good hearing. Hearing was preserved in cases of small schwannoma not exceeding 2cm. Among 21 patients who underwent bilateral operations hearing was preserved in 3 out of 7 cases when smaller tumor or better hearing level side was attempted at first surgery. In contrary none of the 14 patients retained hearing when the first operation concerned the worse-hearing ear. Among 14 tumors up to 2cm there was only one case of moderately severe facial nerve dysfunction (House–Brackmann Grade IV) in the long follow-up.

Conclusion

Early surgical intervention for vestibular schwannoma in NF2 patient is a viable management strategy to maintain hearing function and preserve facial nerve function.

Abstract

Objective

Guidelines for appropriate management of vestibular schwannomas in NF2 patients are controversial. In this paper we reviewed our experience with patients with NF2 for the results of surgical treatment with particular reference to hearing and facial nerve preservation.

Methods

We included in the study 30 patients (16 women and 14 men) with the diagnosis of NF2 treated in our department between 1998 and 2014 who underwent surgery for vestibular schwannoma removal with a follow-up for at least 1 year. In 3 cases, the vestibular schwannomas were unilateral. Six patients with bilateral vestibular schwannomas underwent unilateral procedure. Therefore, 51 acoustic tumors were studied in 30 patients.

Results

No operative death we noted. Significant deterioration to the non-functional level occurred in 19 out of 22 cases with well-preserved preoperative hearing. Only three ears maintained their preoperative good hearing. Hearing was preserved in cases of small schwannoma not exceeding 2cm. Among 21 patients who underwent bilateral operations hearing was preserved in 3 out of 7 cases when smaller tumor or better hearing level side was attempted at first surgery. In contrary none of the 14 patients retained hearing when the first operation concerned the worse-hearing ear. Among 14 tumors up to 2cm there was only one case of moderately severe facial nerve dysfunction (House–Brackmann Grade IV) in the long follow-up.

Conclusion

Early surgical intervention for vestibular schwannoma in NF2 patient is a viable management strategy to maintain hearing function and preserve facial nerve function.

Get Citation

Keywords

Vestibular schwannoma, Hearing preservation, Neurofibromatosis type 2, Surgical management

About this article
Title

Strategy for the surgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 49, No 5 (2015)

Pages

295-301

DOI

10.1016/j.pjnns.2015.06.008

Bibliographic record

Neurol Neurochir Pol 2015;49(5):295-301.

Keywords

Vestibular schwannoma
Hearing preservation
Neurofibromatosis type 2
Surgical management

Authors

Arkadiusz Nowak
Tomasz Dziedzic
Tomasz Czernicki
Przemysław Kunert
Krzysztof Morawski
Kazimierz Niemczyk
Andrzej Marchel

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