Acoustic neuroma surgery: Difference between revisions

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{{CMG}} {{AE}}{{M.B}}
{{CMG}} {{AE}}{{M.B}}
==Overview==
==Overview==
[[Surgery]] is the mainstay of treatment for acoustic neuroma. Patient with age under 65 years and/or medium to large-grade tumors and/or significant hearing loss, and/or higher headache severity scores will have more satisfying outcomes from surgery in comparison with observation. There are three main surgical approaches for the removal of an acoustic neuroma: translabyrinthine, retrosigmoid or sub-occipital, and middle [[fossa]]. Selection of a particular approach is based on several factors, including the size and location of the tumor and whether or not preservation of hearing is a goal.
[[Surgery]] is the mainstay of treatment for acoustic neuroma. [[Patient|Patients]] with age under 65 years, medium to large-grade [[Tumor|tumors]], significant [[Hearing impairment|hearing loss]], or higher [[headache]] severity scores will have more satisfying outcomes from [[surgery]] in comparison with [[observation]]. There are three main [[Surgery|surgical approaches]] for the removal of an acoustic neuroma: [[Translabyrinthine approach|translabyrinthine]], retrosigmoid or [[Occipital|sub-occipital]], and middle [[fossa]]. Selection of a particular approach is based on several factors including the size and location of the [[tumor]] and whether or not preservation of [[Hearing (sense)|hearing]] is a goal.


== Indications ==
== Indications ==
Indications for surgery for acoustic neuroma include:<ref>{{Cite journal
Indications for [[surgery]] include:<ref>{{Cite journal
<nowiki> </nowiki><nowiki>|</nowiki> author = [[Jason C. Nellis]], [[Jeff D. Sharon]], [[Seth E. Pross]], [[Lisa E. Ishii]], [[Masaru Ishii]], [[Jacob K. Dey]] & [[Howard W. Francis]]
<nowiki> </nowiki><nowiki>|</nowiki> author = [[Jason C. Nellis]], [[Jeff D. Sharon]], [[Seth E. Pross]], [[Lisa E. Ishii]], [[Masaru Ishii]], [[Jacob K. Dey]] & [[Howard W. Francis]]
  | title = Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment
  | title = Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment
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}}</ref>
}}</ref>
* Age < 65 years old
* Age < 65 years old
* Moderately large to large tumor
* Moderately large to large [[tumor]]
* Growing tumors
* Growing [[Tumor|tumors]]
* Significant hearing loss
* Significant [[Hearing impairment|hearing loss]]
* Higher headache severity scores
* Higher [[headache]] severity scores


==Surgery==
==Surgery==
[[Surgery]] is the mainstay of treatment for acoustic neuroma. Selection of a particular approach is based on several factors, including the size and location of the tumor and whether or not preservation of hearing is a goal. There are three standard surgical approaches for the excision of an acoustic neuroma:<ref>{{Cite journal
[[Surgery]] is the mainstay of treatment for acoustic neuroma. Selection of a particular approach is based on several factors including the size and location of the [[tumor]] and whether or not preservation of [[Hearing (sense)|hearing]] is a goal. There are three standard [[Surgery|surgical approaches]] for the [[excision]] of an acoustic neuroma:<ref>{{Cite journal
  | author = [[Marc Bennett]] & [[David S. Haynes]]
  | author = [[Marc Bennett]] & [[David S. Haynes]]
  | title = Surgical approaches and complications in the removal of vestibular schwannomas
  | title = Surgical approaches and complications in the removal of vestibular schwannomas
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  | pmid = 26623224
  | pmid = 26623224
}}</ref>
}}</ref>
* Translabyrinthine approach
* [[Translabyrinthine approach]]
* Retromastoid suboccipital approach
* Retromastoid suboccipital approach
* Middle fossa approach
* Middle [[fossa]] approach


=== Translabyrinthine approach ===
=== Translabyrinthine approach ===
* The translabyrinthine approach is considered for acoustic tumors larger than 3 cm and for smaller tumors when hearing preservation is not a concern. In this method the incision is performed behind the ear provides excellent exposure of lateral end of the internal auditory canal and the lateral brain stem and has the advantage to reduce the probability of facial nerve damage.<ref>{{Cite journal
* The [[translabyrinthine approach]] is considered for [[Tumor|tumors]] larger than 3 cm and for smaller [[Tumor|tumors]] when [[Hearing (sense)|hearing]] preservation is not a concern.  
* This method has the advantage of reduced probability of [[facial nerve]] damage.<ref>{{Cite journal
  | author = [[T. H. Lanman]], [[D. E. Brackmann]], [[W. E. Hitselberger]] & [[B. Subin]]
  | author = [[T. H. Lanman]], [[D. E. Brackmann]], [[W. E. Hitselberger]] & [[B. Subin]]
  | title = Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach
  | title = Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach
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*
*


===Retromastoid suboccipital approach===
===Retromastoid Suboccipital Approach===
* The suboccipital approach is considered for all acoustic tumors with or without attempt to conserve hearing.In this method the incision is performed behind mastoid  near the back of the head provides  an opening in the skull. thereby Any size tumor can be removed with this approach.<ref>{{Cite journal
* The [[Occipital|suboccipital]] approach is considered for all acoustic [[Tumor|tumors]] with or without the concern of [[Hearing (sense)|hearing]] preservation.
* Any size [[tumor]] can be removed with this approach.<ref>{{Cite journal
  | author = [[Pk Nayak]] & [[Rvs Kumar]]
  | author = [[Pk Nayak]] & [[Rvs Kumar]]
  | title = Retromastoid-sub occipital: A novel approach to cerebello pontine angle in acoustic neuroma surgery-our experience in 21 cases
  | title = Retromastoid-sub occipital: A novel approach to cerebello pontine angle in acoustic neuroma surgery-our experience in 21 cases
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}}</ref>
}}</ref>


===Middle fossa approach===
===Middle Fossa Approach===
* The middle fossa approach is considered for acoustic tumors smaller than 1.5 cm when hearing preservation is optimal. In this method a craniotomy is performed in the temporal bone provides access to the tumor from the upper surface of the internal auditory canal, preserving the inner ear structures.<ref>{{Cite journal
* The middle [[fossa]] approach is considered for [[Tumor|tumors]] smaller than 1.5 cm when [[Hearing (sense)|hearing]] preservation is optimal.  
* This approach can preserve the [[inner ear]] structures.<ref>{{Cite journal
  | author = [[William F. House]] & [[Clough Shelton]]
  | author = [[William F. House]] & [[Clough Shelton]]
  | title = Middle fossa approach for acoustic tumor removal. 1992
  | title = Middle fossa approach for acoustic tumor removal. 1992
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}}</ref>
}}</ref>


Below table summarizes and simplifies approaches for management of acoustic neuroma:  
Below table summarizes and simplifies approaches for the management of acoustic neuroma:  
{| class="wikitable"
{| class="wikitable"
! style="background-color: #0080FF; font-weight: bold;" | Tumor Size
! style="background-color: #0080FF; font-weight: bold;" | Tumor Size
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| colspan="2" |  
| colspan="2" |  
|-
|-
| rowspan="2" | No tumor growth
! rowspan="2" |No [[tumor]] growth
| First
| First
| Observation
| [[Observation]]
|-
|-
| Second
| Second
| Focused radiation or surgery
| Focused [[Radiation therapy|radiation]] or [[surgery]]
|-
|-
| rowspan="3" | With tumor growth
! rowspan="3" | With [[tumor]] growth
| First
| First
| Focused radiation or surgery
| Focused [[Radiation therapy|radiation]] or [[surgery]]
|-
|-
| Adjunct
| Adjunct
| Salvage radiation or surgery
| Salvage [[Radiation therapy|radiation]] or [[surgery]]
|-
|-
| Second
| Second
| Observation
| [[Observation]]
|-
|-
| style="background-color: #819FF7; font-weight: bold;" | Tumor 1.5 to 3cm
| style="background-color: #819FF7; font-weight: bold;" | Tumor 1.5 to 3cm
| colspan="2" |  
| colspan="2" |  
|-
|-
| rowspan="3" | No tumor growth
! rowspan="3" | No [[tumor]] growth
| First
| First
| Focused radiation or surgery
| Focused [[Radiation therapy|radiation]] or [[surgery]]
|-
|-
| Adjunct
| Adjunct
| Salvage radiation or surgery
| Salvage [[Radiation therapy|radiation]] or [[surgery]]
|-
|-
| Second
| Second
| Observation
| [[Observation]]
|-
|-
| rowspan="3" | With tumor growth
! rowspan="3" | With [[tumor]] growth
| First
| First
| Focused radiation or surgery
| Focused [[Radiation therapy|radiation]] or [[surgery]]
|-
|-
| Adjunct
| Adjunct
| Salvage radiation or surgery
| Salvage [[Radiation therapy|radiation]] or [[surgery]]
|-
|-
| Second
| Second
| Observation
| [[Observation]]
|-
|-
| style="background-color: #819FF7; font-weight: bold;" | Tumor > 3cm
| style="background-color: #819FF7; font-weight: bold;" | Tumor > 3cm
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| rowspan="3" |
| rowspan="3" |
| First
| First
| Surgery
| [[Surgery]]
|-
|-
| Second
| Second
| Observation
| [[Observation]]
|}
|}


Latest revision as of 20:08, 26 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohsen Basiri M.D.

Overview

Surgery is the mainstay of treatment for acoustic neuroma. Patients with age under 65 years, medium to large-grade tumors, significant hearing loss, or higher headache severity scores will have more satisfying outcomes from surgery in comparison with observation. There are three main surgical approaches for the removal of an acoustic neuroma: translabyrinthine, retrosigmoid or sub-occipital, and middle fossa. Selection of a particular approach is based on several factors including the size and location of the tumor and whether or not preservation of hearing is a goal.

Indications

Indications for surgery include:[1][2][3]

Surgery

Surgery is the mainstay of treatment for acoustic neuroma. Selection of a particular approach is based on several factors including the size and location of the tumor and whether or not preservation of hearing is a goal. There are three standard surgical approaches for the excision of an acoustic neuroma:[4][5][6]

Translabyrinthine approach

Retromastoid Suboccipital Approach

  • The suboccipital approach is considered for all acoustic tumors with or without the concern of hearing preservation.
  • Any size tumor can be removed with this approach.[9]

Middle Fossa Approach

  • The middle fossa approach is considered for tumors smaller than 1.5 cm when hearing preservation is optimal.
  • This approach can preserve the inner ear structures.[10]

Below table summarizes and simplifies approaches for the management of acoustic neuroma:

Tumor Size Treatment line Treatment
Tumor < 1 to 1.5 cm
No tumor growth First Observation
Second Focused radiation or surgery
With tumor growth First Focused radiation or surgery
Adjunct Salvage radiation or surgery
Second Observation
Tumor 1.5 to 3cm
No tumor growth First Focused radiation or surgery
Adjunct Salvage radiation or surgery
Second Observation
With tumor growth First Focused radiation or surgery
Adjunct Salvage radiation or surgery
Second Observation
Tumor > 3cm
First Surgery
Second Observation

References

  1. ↑ {{Cite journal | author = Jason C. Nellis, Jeff D. Sharon, Seth E. Pross, Lisa E. Ishii, Masaru Ishii, Jacob K. Dey & Howard W. Francis | title = Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment | journal = [[Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology]] | volume = 38 | issue = 3 | pages = 392–399 | year = 2017 | month = March | doi = 10.1097/MAO.0000000000001292 | pmid = 27930442 }}
  2. ↑ {{Cite journal | author = D. M. Kaylie, E. Gilbert, M. A. Horgan, J. B. Delashaw & S. O. McMenomey | title = Acoustic neuroma surgery outcomes | journal = [[Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology]] | volume = 22 | issue = 5 | pages = 686–689 | year = 2001 | month = September | pmid = 11568680 }}
  3. ↑ A. Wright & R. Bradford (1995). "Management of acoustic neuroma". BMJ (Clinical research ed.). 311 (7013): 1141–1144. PMID 7580712. Unknown parameter |month= ignored (help)
  4. ↑ Marc Bennett & David S. Haynes (2007). "Surgical approaches and complications in the removal of vestibular schwannomas". Otolaryngologic clinics of North America. 40 (3): 589–609. doi:10.1016/j.otc.2007.03.007. PMID 17544697. Unknown parameter |month= ignored (help)
  5. ↑ D. E. Brackmann & J. D. Green (1992). "Translabyrinthine approach for acoustic tumor removal". Otolaryngologic clinics of North America. 25 (2): 311–329. PMID 1630831. Unknown parameter |month= ignored (help)</ref <ref>Tyler Cole, Anand Veeravagu, Michael Zhang, Tej Azad, Christian Swinney, Gordon H. Li, John K. Ratliff & Steven L. Giannotta (2015). "Retrosigmoid Versus Translabyrinthine Approach for Acoustic Neuroma Resection: An Assessment of Complications and Payments in a Longitudinal Administrative Database". Cureus. 7 (10): e369. doi:10.7759/cureus.369. PMID 26623224. Unknown parameter |month= ignored (help)
  6. ↑ Tyler Cole, Anand Veeravagu, Michael Zhang, Tej Azad, Christian Swinney, Gordon H. Li, John K. Ratliff & Steven L. Giannotta (2015). "Retrosigmoid Versus Translabyrinthine Approach for Acoustic Neuroma Resection: An Assessment of Complications and Payments in a Longitudinal Administrative Database". Cureus. 7 (10): e369. doi:10.7759/cureus.369. PMID 26623224. Unknown parameter |month= ignored (help)
  7. ↑ T. H. Lanman, D. E. Brackmann, W. E. Hitselberger & B. Subin (1999). "Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach". Journal of neurosurgery. 90 (4): 617–623. doi:10.3171/jns.1999.90.4.0617. PMID 10193604. Unknown parameter |month= ignored (help)
  8. ↑ {{Cite journal | author = Bulent Mamikoglu, Richard J. Wiet & Carlos R. Esquivel | title = Translabyrinthine approach for the management of large and giant vestibular schwannomas | journal = [[Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology]] | volume = 23 | issue = 2 | pages = 224–227 | year = 2002 | month = March | pmid = 11875354 }}
  9. ↑ Pk Nayak & Rvs Kumar (2011). "Retromastoid-sub occipital: A novel approach to cerebello pontine angle in acoustic neuroma surgery-our experience in 21 cases". Journal of neurosciences in rural practice. 2 (1): 23–26. doi:10.4103/0976-3147.80084. PMID 21716801. Unknown parameter |month= ignored (help)
  10. ↑ William F. House & Clough Shelton (2008). "Middle fossa approach for acoustic tumor removal. 1992". Neurosurgery clinics of North America. 19 (2): 279–288. doi:10.1016/j.nec.2008.02.009. PMID 18534340. Unknown parameter |month= ignored (help)


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