Suboccipital resection of a medial acoustic neuroma with hearing preservation (original) (raw)
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The Laryngoscope, 1997
Three hundred sixty-four patients referred to the Chicago Otology Group for acoustic tumor removal between 1981 and 1995 were reviewed in a retrospective fashion. Of this group, 60 patients were candidates for hearing preservation surgery and thus underwent one of two surgical approaches to remove the tumor and preserve hearing. Eighteen patients had tumor removal via the middle cranial fossa approach, and 42 patients had tumor removed via the retrosigmoid approach. Of the 42 patients who underwent retrosigmoid removal, 33% had hearing preserved overall. Of the 18 patients in the middle fossa group, 44% had hearing preserved overall. The average tumor size of patients with preserved hearing in the retrosigmoid group was 1.4 cm, and in the middle fossa group was 0.74 cm. Of significance was the fact that in both groups of patients with a tumor of 1.5 cm or less there was a 50% chance of hearing preservation. In the group of patients with tumors larger than 1.6 cm there was only a 16% chance of preserving hearing. We propose that these data can be used for better counseling of patients preoperatively as to the chances of hearing preservation and the type of approach appropriate for each case.
Journal of Neurosurgery, 1985
✓ Microsurgical techniques have made it possible to identify and preserve the cochlear nerve from its origin at the brain stem and along its course through the internal auditory canal in patients undergoing removal of small or medium-sized acoustic neuromas or other cerebellopontine angle (CPA) tumors. In a consecutive series of 100 patients with such tumors operated on between 1975 and 1981, an attempt was made to preserve the cochlear nerve in 23. The decision to attempt to preserve hearing was based on tumor size and the degree of associated hearing loss. In cases of unilateral acoustic neuroma, the criteria for attempted preservation of hearing were tumor size (2.5 cm or less), speech reception threshold (50 dB or less), and speech discrimination score (60% or greater). In patients with bilateral acoustic neuromas or tumors of other types, the size and hearing criteria were significantly broadened. All patients were operated on through a suboccipital approach. Hearing was preser...
Neurosurgery, 2010
BACKGROUND For hearing preservation in acoustic neuroma (AN) surgery, the middle fossa (MF) or retrosigmoid (RS) approach can be used. Recent literature advocates the use of the MF approach, especially for small ANs. OBJECTIVE To present our critical analysis of operative results comparing these 2 approaches. METHODS We reviewed 504 consecutive AN resections performed between November 1998 and September 2007 and identified 43 MF and 82 RS approaches for tumors smaller than 1.5 cm during hearing preservation surgery. Individual cases were examined postoperatively with respect to hearing ability, facial nerve activity, operative time, blood loss, and symptoms resulting from retraction of the cerebellar or temporal lobes. RESULTS Good hearing function (American Academy of Otolaryngology-Head and Neck Surgery class B or better) was preserved in 76.7% of patients undergoing surgery via the MF approach and in 73.2% of the RS group (P = .9024). Temporary facial nerve weakness was more freq...
Suboccipital surgery for acoustic neuroma
Clinical Otolaryngology, 1996
Suboccipital surgery for acoustic neuroma A retrospective study was performed on 106 consecutive patients with an acoustic neuroma who underwent suboccipital surgery for the first time between 1980 and 1992. Complete follow-up data were available for all the patients, including regular imaging up to 1 January 1994. Incomplete removal of the tumours was chosen in preference to radical surgery in a large proportion of the patients, to avoid the risk of post operative morbidity. The recurrence rate in this series was 20%. Comparison of the results of suboccipital surgery to those obtained using other surgical approaches, while taking the tumour size into consideration, showed that better results can be obtained after total removal of the tumour without any additional risk to post-operative facial nerve function. The long-term results of subtotal removal using the suboccipital approach were disappointing. It is therefore necessary to review the indications for non-radical surgery in patients with an acoustic neuroma. Keywords acoustic neuroma suboccipital approach facial nerve recurrence rate Various techniques have been developed for the removal of an acoustic neuroma. To decide which of these techniques is the most suitable for a particular patient, it is necessary to consider his/her age, the level of hearing loss on the affected unilateral acoustic neuroma which had not been operated on previously. In this study we analysed the results of the 106 consecutive patients with an acoustic neuroma who were operated on for side, the experience and preference of the surgeon. At the the first time between 1980 and 1992. We found that 21 pat-University of Nijmegen, the majority of patients with an ients (20%) had developed one or more tumour recurrences acoustic tumour have been operated on using the suboccipital or translabyrinthine/transotic approach.1 Follow-up results are available over a period of 13 years. A retrospective study was performed to evaluate the effect of the completeness of surgery, tumour size and surgical approach, in relation to pre-operative and post-operative hearing levels, long-term post-operative facial nerve function and tumour recurrence.
Hearing Preservation after Acoustic Neuroma Surgery
Skull Base Surgery, 2000
With the advent of microsurgery, techniques for a removal of acoustic neuroma (AN) have improved over the years. We are at a point where tumor extirpation is not the only goal, as preservation of normal cochlear function can be obtained and expected as well, especially in the case of small tumors. The advent of MRI has enabled the surgeon to detect small tumors in asymptomatic patients; thus, preservation of hearing becomes more critical, with as many as 20% of patients with AN presenting as candidates for hearing preservation.' This article presents the hearing results in our series of patients with AN, operated on for hearing preservation surgery by the middle fossa (MF) or the suboccipital (SO) approach, as well as the factors influencing the final outcome.
Long-term results of the first 500 cases of acoustic neuroma surgery
Otolaryngology - Head and Neck Surgery, 2001
OBJECTIVE: this retrospective study focuses on 2 outcome results after surgical Intervention for acoustlo neuroma: (1) facial nerve status, and (2) hearing preservation. STUOY DESIGN: A total of 484 patients with an acoustic neuroma. RESULTS: Postoperative facial nerve outcom.. were IIgnltfcanfly different (P< 0,007) according to the size of the tumors. Tumor IIze had even more Intluence on the immediate poIfoperaflve ffIIUlfI. In addition, Bfafllflcal slgnltfcance (P < 0.05) WQI demonltrafed In comparing facial nerve outcom.. with the sur-Qeon', surgical experience, we also noted #hat as lire patient's age Inct'ease6, the HkeIIhood lor facial dyafunctlon may Inc.. . lor all poItoperatIve Inter-WJII. 7he overall success rate 01retainingUI8IuI hearIng was 27'1, (26 0196). Class A IIearIng was retained In 66'1, (1001 75)of easel operated on thlOUQh middle folia aPPfOOCh In the 1a115 yecn. CONCLUSION: this study demonstrates that tumor lIze and surgeon's experience are the moat IIgnlflcant factors Influencing the facial nerve status and hearing outcome after removal of acoustic neuroma.
Journal of Neurosurgery, 1997
✓ In a series of 514 consecutive operations for complete excision of acoustic neuromas, 94 procedures were performed via a retrosigmoid approach to preserve the patient's hearing. Twenty-six of these procedures (5.1%) were performed in cases of intracanalicular tumor and 68 (13.2%) were for larger lesions in which most of the tumor was located medial to the porus acusticus within the cerebellopontine angle. Preservation of useful hearing was achieved in 13 (50%) of 26 patients with intracanalicular tumors and in 20 (29%) of 68 with larger tumors. A trend toward higher success rates in intracanalicular tumors appears to be present, although the difference is not statistically significant (p = 0.09). Normal or nearnormal facial function (House and Brackmann Grades I and II) was present postoperatively in 25 (96%) of 26 patients. Indications for treatment of intracanalicular acoustic neuromas are considered and treatment alternatives are reviewed. Results from other series reportin...
Annals of the Royal College of Surgeons of England, 1995
An audit of surgery for acoustic neuroma was carried out to determine the frequency and nature of postoperative symptoms and their impact upon the patient's quality of life and vocation. Fifty-six patients were interviewed between 6 months and 5 years (mean 26 months) after surgical excision of an acoustic neuroma. The objective surgical results in these patients are good, with normal or near normal functional preservation rates of 80% for the facial nerve (House-Brackmann grade I/II), and 27.3% for a previously functioning acoustic nerve. Despite this there was no significant overall reduction in the reported occurrence of balance problems, tinnitus, headache and other neurological sequelae of the tumour after surgical excision. In 20% of the patients persistent symptoms, including deafness and facial weakness, had prevented the resumption of former social activities. As a result of these symptoms 8.6% of the patients were certified medically unfit for work, but of those employ...