Ahead of Print: Retrosigmoid Intradural Inframeatal Approach

Background: Surgery of lesions of the petrous apex involving the inframeatal/infralabyrinthine area is challenging and related to high risk of complications. Various extensive skull base approaches have been utilized.

Objective: To present and evaluate our experience with a new hearing preserving extension of the retrosigmoid approach to the inframeatal/infralabyrinthine area.

Methods: The approach was used in three patients harboring lesions in the petrous apex with variable extension in the inframeatal/infralabyrinthine region. The surgical accessibility of the lesions offered by the approach, the completeness of tumor removal, and the outcome, in particular the functional outcome and complication rate, were assessed.

Ahead of Print: Contemporary Surgical Management of Vestibular Schwannomas

Background: Despite advanced microsurgical techniques, more refined instrumentation, and expert team management, there is still a significant incidence of complications in vestibular schwannoma (VS) surgery.

Objective: To analyze complications from the microsurgical treatment of VS by an expert surgical team and to propose strategies for minimizing such complications.

Methods: Surgical outcomes and complications were evaluated in a consecutive series of 410 unilateral VSs treated from 2000 to 2009. Clinical status and complications were assessed postoperatively (within 7 days) and at the time of follow-up (range: 1 to 116 months; mean: 32.7 months).

Ahead of Print: Middle Fossa Hearing Preservation

Background: The incidence of small vestibular schwannomas in patients with serviceable hearing is increasing due to the widespread use of MRI. The middle fossa approach provides the patient with an opportunity for tumor removal with hearing preservation.

Objective: To determine the rate of hearing preservation and facial nerve outcomes after removal of a vestibular schwannoma using the middle fossa approach.

Methods: A retrospective case review at a tertiary, academic medical center was performed identifying patients from 1998 through 2008 that underwent removal of a vestibular schwannoma by the middle fossa approach. Preoperative and postoperative audiograms were compared to determine hearing preservation rates. In addition, facial nerve outcomes at last follow-up were recorded.

Ahead of Print: Implications of Cystic Features in Vestibular Schwannomas of Patients Undergoing Microsurgical Resection

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BACKGROUND: Cystic vestibular schwannomas (VS) are described as more aggressive than solid tumors.

OBJECTIVE: We examined 468 VS patients to evaluate whether the presence of cystic components in VS may be an important feature for predicting post-operative outcome.

METHODS: We selected all VS patients from a prospectively collected database (1984-2009) who underwent microsurgical resection for vestibular schwannoma.   Hearing data were analyzed using AAO-HNS. Facial nerve dysfunction was analyzed using the House-Brackmann scale.  We utilized univariate comparisons to determine the clinical impact of cystic changes on pre-operative and post-surgical hearing and facial nerve preservation.

Ahead of Print: Natural History of Hearing Deterioration in Intracanalicular Vestibular Schwannoma

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BACKGROUND: Intracanalicular vestibular schwannomas have a range of treatment options that can preserve hearing: microsurgery, stereotactic radiotherapy, and conservative observation.

OBJECTIVE: To evaluate the natural course of hearing deterioration during a period of conservative observation.

METHODS: A retrospective case review was performed on 47 patients with a unilateral intracanalicular vestibular schwannoma. Evaluation of growth was monitored by repeat MRI scanning. Repeated pure-tone and speech audiometry results were evaluated for subgroups of patients showing growth or no growth and by subsite location of tumor in the internal auditory canal.