Schwannoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]

Overview

The feasibility of surgery depends on the stage of schwannoma at diagnosis. Surgery is the mainstay of treatment for schwannoma. There are three main approaches like translybyrinthine, retrosigmoid, middle fossa. The common complications of surgery include vertigo, hearing loss is another important complication associated with the operation, post-operative headache, cerebrospinal fluid (CSF) leakage, facial paralysis

Indications

• Surgical intervention is recommended the management of schwannoma.

Surgery

• The feasibility of surgery depends on the stage of schwannoma at diagnosis.
• Surgery is the mainstay of treatment for schwannoma.
• The following table compares the different type of surgical approaches for vestibular schwannoma management.

Indications, benefits and disadvantages of lateral skull base approaches for VS resection.

	Translybyrinthine	Retrosigmoid	Middle fossa
Indications	Non-serviceable hearing; any IAC or CPA VS	VS with large CPA component; medial IAC VS	Small lateral IAC VS (<0.5 cm); small medial IAC VS with < 1 cm CPA component
Advantages	Minimal brain retraction	Panoramic CPA exposure; better facial nerve and hearing preservation for medial VS	Better exposure lateral IAC
Disadvantages	Complete hearing loss; difficult approach for CPA VS ventral to porus acusticus; risk for facial nerve injury	Limited access to lateral IAC; potential for cerebellar and brainstem injury	Limited PF access; temporal lobe retraction; risk for facial nerve injury

• The common complications of surgery include the following:
  • Vertigo
  • Hearing loss
  • Post-operative headache
  • Cerebrospinal fluid (CSF) leakage
  • Facial paralysis