Free Editor Choice: 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 surgery.

Objective: To analyze complications from the microsurgical treatment of vestibular schwannoma 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 vestibular schwannomas treated from 2000 to 2009. Clinical status and complications were assessed postoperatively (within 7 days) and at the time of follow-up (range, 1-116 months; mean, 32.7 months).

Free Editor Choice with CME: Management of Bilateral Vestibular Schwannomas

Background: As new treatment modalities develop for the management of vestibular schwannomas (VS) in patients with neurofibromatosis type 2, it remains crucial to ascertain the natural history of the disease.

Objective: To determine the relationship between hearing and tumor growth in patients undergoing conservative VS management.

Methods: Patients harboring bilateral VS with at least 1 year of radiological follow-up were selected. Conservative management was proposed based on the small tumor size and/or serviceable hearing at presentation. Tumor size was calculated by using the 2-component box model and reported as mean tumor diameter. Hearing was evaluated by using pure-tone average and the American Academy of Otololaryngologists and Head and Neck Surgery classification.

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).

Free CME Article: The Electrically Unresponsive FN in VS Surgery

Background: Permanent facial nerve (FN) paresis after vestibular schwannoma surgery is distressing to both the patient and surgeon. Intraoperative electrophysiological testing has proven invaluable in reducing the incidence of FN injury and may assist in prognosticating long-term function.

Objective: To report definitive FN outcomes among a cohort of patients with an unevokable but anatomically intact seventh nerve after microsurgical vestibular schwannoma resection.

Methods: All patients undergoing vestibular schwannoma surgery between 2000 and 2010 at a single tertiary academic referral center were identified. Intraoperative FN monitoring data and definitive FN outcomes were reviewed, and all patients with an anatomically intact but electrically unresponsive FN were included.

Ahead of Print: LECA versus Costotransversectomy

Background: The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are two dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature.

Objective: To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine.

Methods: A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution.