Acoustic neuroma surgery: Difference between revisions
Jump to navigation
Jump to search
| Line 145: | Line 145: | ||
| pmid = 18534340 | | pmid = 18534340 | ||
}}</ref> | }}</ref> | ||
Below table summarizes and simplifies approaches for 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 | ||
Revision as of 20:09, 15 January 2019
|
Acoustic neuroma Microchapters | |
|
Diagnosis | |
|---|---|
|
Treatment | |
|
Case Studies | |
|
Acoustic neuroma surgery On the Web | |
|
American Roentgen Ray Society Images of Acoustic neuroma surgery | |
|
Risk calculators and risk factors for Acoustic neuroma surgery | |
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. 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.
Indications
Indications for surgery for acoustic neuroma include:[1][2][3]
- Age < 65 years old
- Moderately large to large tumor
- Growing tumors
- Significant hearing loss
- Higher headache severity scores
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
- Middle fossa 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.[7][8]
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.[9]
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.[10]
Below table summarizes and simplifies approaches for 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
- ↑ {{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 }}
- ↑ {{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 }}
- ↑ A. Wright & R. Bradford (1995). "Management of acoustic neuroma". BMJ (Clinical research ed.). 311 (7013): 1141–1144. PMID 7580712. Unknown parameter
|month=ignored (help) - ↑ 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) - ↑ 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) - ↑ 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) - ↑ 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) - ↑ {{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 }}
- ↑ 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) - ↑ 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)