Leveron&Nexovas
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 5633  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (126 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 »  Introduction
 »  Materials and Me...
 »  Results
 »  Discussion
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    Viewed10013    
    Printed221    
    Emailed5    
    PDF Downloaded329    
    Comments [Add]    
    Cited by others 30    

Recommend this journal

 


 
ORIGINAL ARTICLE
Year : 2005  |  Volume : 53  |  Issue : 1  |  Page : 41-45

Surgery of vestibular schwannomas: An institutional experience


Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Date of Acceptance15-Dec-2004

Correspondence Address:
Vijendra K Jain
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.15052

Rights and Permissions

 » Abstract 

AIMS: To report management results of vestibular schwannomas (VS) treated surgically in our institute, with particular reference to completeness of tumor excision, facial nerve and hearing preservation and complications of surgery. STUDY DESIGN AND SETTINGS: Retrospective study of 259 patients treated during the years 1988 to 2002. MATERIALS AND METHODS: The facial nerve function and hearing assessment was done according to House-Brackmann [HB] grading and pure tone audiometry (PTA) respectively. All patients were operated by retro-mastoid sub-occipital approach. RESULTS: Most patients had large tumors and had no useful hearing (90%), had disabling cerebellar ataxia (88%) and presented with features of raised intra-cranial pressure (45%). Large sized tumors were in 41.3% and giant sized tumors were in 56% cases. Complete tumor excision was carried out in 96.5% and anatomical preservation of facial nerve was achieved in 79.2% cases. Hearing preservation was achieved in 8 patients. Cerebrospinal fluid leak with or without meningitis and transient lower cranial nerve paresis were common complications. The mortality was 6%. CONCLUSIONS: With experience, complete tumor excision with good facial nerve preservation can be achieved in large tumors. Hearing preservation is difficult in bigger tumors. Prevention and control of infection was a major concern.


Keywords: Vestibular Schwannomas, cerebello-pontine angle, retro-mastoid approach, facial nerve preservation


How to cite this article:
Jain VK, Mehrotra N, Sahu RN, Behari S, Banerji D, Chhabra DK. Surgery of vestibular schwannomas: An institutional experience. Neurol India 2005;53:41-5

How to cite this URL:
Jain VK, Mehrotra N, Sahu RN, Behari S, Banerji D, Chhabra DK. Surgery of vestibular schwannomas: An institutional experience. Neurol India [serial online] 2005 [cited 2022 Oct 6];53:41-5. Available from: https://www.neurologyindia.com/text.asp?2005/53/1/41/15052



 » Introduction Top


There are only a few reports discussing the management consideration in vestibular schwannomas (VS) from India.[1],[2],[3],[4] To quote Ramamurthi, saving life and functions of the lower cranial nerves still forms the main goal in majority of patients who come with large tumors.[5] We report the results of management of vestibular schwannomas in our institute.


 » Materials and Methods Top


Two hundred and sixty-five patients with VS were treated in our Institute from 1988 to December 2002. Six cases were excluded from the study as in three elderly patients only a ventriculo-peritoneal shunt was performed and three patients who had tumor recurrence after surgery in another hospital. Thus, 259 patients included in this study, had their surgery done for the first time at our institute. In 9 patients complete excision of the tumor was not achieved, as part of the tumor capsule was adherent firmly, either to the brainstem or to the facial nerve and could not be safely dissected. Thus the surgical outcome of complete excision of VS was studied in 250 patients.

The clinical records of the patients were reviewed; the facial nerve function was graded according to House-Brackmann [HB6] score pre-operatively, post-operatively, at the time of discharge and at follow up. Pre-operative pure tone audiometry was done in all patients to assess the degree of hearing loss. Criteria for useful hearing was taken as hearing loss <60 decibel (Norstadt Classification for audiometric hearing).[7] Post-operative hearing assessment was done only in those patients who had useful hearing preoperatively. The speech discrimination test was not done.

The tumor size was measured (in CT and/or MRI scan) in three axes that is diameter parallel to the petrous ridge, perpendicular to the petrous ridge or the vertical diameter in the coronal slices. The size of the VS was taken as the largest diameter in any one of these three axes. The tumors were then categorized according to the classification proposed by Jackler[8] et al.

For patients with bilateral tumors, the side operated was considered for categorization.

All the patients were operated via the retro-mastoid sub-occipital transmeatal approach in park-bench position, except for two patients who were operated in sitting position. Cavitron ultrasonic aspirator was used in a few cases. The facial nerve stimulator was not utilized. The intrameatal component of the tumor was removed and the lateral aspect of the intrameatal facial nerve defined, after drilling the roof of internal acoustic meatus (IAM). A piece of muscle was used to seal the drilled IAM in all patients. In the 3 patients during re-exploration for the persistent cerebrospinal fluid (CSF) rhinorrhea, fibrin glue with muscle patch was used to seal the drilled IAM.

All the patients were followed up at 6 weeks, at 3 months, at 6 months and yearly thereafter. The maximum follow up was of 11 years.


 » Results Top


There were 151 males and 108 females with ages ranging from 11 to 78 years. No predilection was observed as far as side or sex were concerned. Eleven patients (4.2%) had bilateral tumors (Neurofibromatosis type-2). In one of these patients bilateral surgery was performed and complete excision of the tumor was achieved on the side with the larger tumor and a sub-total excision was done on the contralateral side after a period of time. Two of these patients had coexisting small neurofibroma arising from lower cranial nerves that was asymptomatic and was detected during surgery. These tumors were not resected.

There was no useful hearing in approximately 90% patients. Varying degrees of facial nerve paresis was observed in 65.2% cases. The other symptoms were of raised intra-cranial pressure, trigeminal dysfunction and cerebellar ataxia [Table - 1].

One hundred and forty five patients (56%) had giant, 41.3% had large and 2.7% of patients had medium sized tumors [Figure - 1].

Twenty-two patients underwent ventriculo-peritoneal shunt procedure prior to the definitive surgery. Thirteen (5.2%) patients required ventriculo-peritoneal shunt surgery in the post-operative period.

Complete excision of the VS along with intra-canalicular (intra-meatal) portion was achieved in 96.5% (250/259) of patients. Staged tumor resection was done in 5 patients. Out of the nine patients in whom complete excision could not be achieved; 3 patients had tumor adhered to the brainstem and in 5 patients the tumor was adhered to the facial nerve (part of the tumor was left to avoid nerve injury). In one patient, only a subtotal removal was possible due to massive intra-operative hemorrhage.

Facial nerve was anatomically preserved in 79.2% (198/250) patients with complete tumor excision. Nine patients died in post-operative period, and 189 patients were analyzed for facial nerve function at time of discharge. The facial nerve preservation rates were 76.5% for giant size VS and increased rates were observed with tumors of smaller sizes (81.3% for large and 100% for medium size) [Table - 2]. Further, the functional status of the facial nerve at follow up were better in patients with relatively smaller tumors who had mild grade facial paresis (H&B Grade 1 and 2) pre-operatively [Table - 3].

Twenty-seven patients had useful hearing preoperatively. Useful hearing could be retained in 8 patients (29.6%) postoperatively. Amongst these 8 patients, 1 had giant size tumor, 4 had large tumors and 3 had medium sized tumor.

Cerebrospinal fluid (CSF) leak occurred in 4% (10/250) patients. CSF rhinorrrhea and CSF otorrhea occurred in 6 and 2 patients respectively. Most cases were managed conservatively with or without lumbar puncture and CSF drainage. Three patients required re-exploration and plugging of the drilled internal auditory meatus (IAM) for CSF leak. Three patients (1.2%) developed operative site hematoma and 3 patients had an extra-dural hematoma (1.2%) and all of them underwent re-exploration surgery. Twenty patients (8.0%) developed post-operative meningitis. Eighteen patients responded to the anti-meningitic treatment. Vertebral artery injury occurred in 2 (0.8%) patients; the procedure was abandoned and one patient underwent tumor excision at a later date. Both these patients were discharged without any neurological deficit due to vertebral artery injury. Post-operative lower cranial nerve paresis developed in 17 (6.8%) patients [Table - 4]. These patients required nasogastric tube feeding and three of them required temporary tracheostomy. However the lower cranial nerve paresis improved functionally during 4-6 weeks follow-up.

The mortality was in 6% patients (15/250). Massive cerebellar edema leading to brainstem failure occurred in 3 patients. Air embolism (which includes one case operated by sitting position) and meningitis were responsible for mortality in 2 patients each. Massive intra-operative haemorrhage, operative site haematoma, post-operative myocardial infarction, fulminant septicemia and severe anaphylactic reaction due to mismatched blood transfusion caused mortality in one patient each. No definite cause of death could be established in three patients who could not be revived following surgery.


 » Discussion Top


The last century has witnessed a considerable evolution in the management of VS with contributions from eminent neurosurgeons like Cushing who was the first to reduce mortality rates from 50% to 11%[9]. Later Walter Dandy reported complete excision with no mortality in his series of 5 patients.[9] In 1964, House[10] introduced operating microscope for trans-labyrinthine approach and a year later in 1965 Rand and Kurze[11] utilized the operating microscope for trans-meatal posterior fossa approach. With the availability of operating microscope, safe modern anesthesia and refinements in the microsurgical technique the goal of VS surgery has shifted from complete excision to excellent facial nerve function and preservation of cochlear nerve function. During the past quarter of century the advances in neuro-imaging like high resolution computed tomography and multiplanar magnetic resonance imaging have resulted in early detection of VS and an increased frequency of smaller lesions being operated.

In this present study, 97% of patients had either a large or giant sized VS. Ninety percent of patients had no useful hearing at the time of presentation. In contrast to certain western literatures,[12],[13] majority of our patients sought medical attention at a stage when they developed disabling cerebellar ataxia (88.4%) and/or the symptoms of raised intra-cranial pressure.

Pre-operative ventriculo-peritoneal shunt is not required in majority of the patients, but some patients report late with signs of raised intra-cranial pressure requiring emergency shunt procedures. In the present study the pre-operative shunt was done in 8 patients at our center and 14 patients had shunt done elsewhere before they were referred for definitive surgery. The incidence of preoperative shunt was as high as 66% in the series reported by Ramamurthi et al.[5]

Complete tumor excision was achieved in 96.5% (250/259) of the patients. Yamakani et al,[14] reported complete tumor excision in 86% patients by retro-mastoid approach for large acoustic tumors. Lanman et al reported a higher rate (96.3%) of total removal by the trans-labrynthine approach.[13] Ebersold et al[15] achieved total tumor resection in 97.2% (249/256) by retro-mastoid approach for tumors of all sizes. Samii et al[16] have reported complete excision in 97.9% patients by sub-occipital trans-meatal approach.

Anatomical preservation of facial nerve was achieved in 79.2% (198/250) patients. In the giant category facial nerve preservation was 76.5% (108/141) and in the large category was 81.3% (83/102) and 100% (7/7) for medium size tumors. In some western literatures the anatomical preservation rate is 80-90% with the removal of large tumors either by the trans-lybrinthine approach[13],[17],[18] or by the retro-mastoid approach.[12],[16],[19] Other authors have reported the anatomical preservation of the facial nerve for tumors > 4 cms ranging from 89% to 92% by trans-labyrinthine approach[20],[21],[22],[23] and 78%-94% by sub-occipital-retro-sigmoid approach[19],[23] Samii and Matthias reported preservation rate of 87% with tumor size >3 cm until 1988, but in most recent 200 cases preservation rates rose to 94% independent of tumor size.[23] Moreover in our series after 1995 (in recent 166 cases) we have achieved facial nerve preservation rate of 84.3% observing that experience results in better outcome. The preservation rate was 69% (58/84) until 1995 and had subsequently increased to 84.3% (140/166) [Figure - 2]. This data confirms that there is a learning curve for surgery of VS. According to Whittaker et al a surgeon operating less than 12 cases per year cannot expect to get equal results of large series.[24] The size of the tumor, is one of the important factors responsible for the preservation of the facial nerve, having a reciprocal relationship i.e. larger the size of tumor lesser the chances of preservations[9],[13],[19] was also observed in this present study.

In the present study 10.4% (27/259) patients had pre-operatively useful hearing. Post-operative hearing could be preserved in 8 of these27 patients (29.6%) in spite of their giant size in 1, large in 4 and medium in 3 patients. Though the retro-mastoid approach gives the surgeon great opportunity for saving hearing in small sized tumors, but in tumors more than 4 cm, the post-operative hearing is usually very poor as observed by Ebersold et al,[19] who reported no post-operative hearing in any of patients with tumor size more than 4 cm. According to Samii et al, patients with large tumor (30 mm x 20 mm) hearing were preserved in 23.6% (78/330).[7] Almost all authors agree that hearing preservation is more likely with smaller tumors with good pre-operative hearing.[25],[26],[27],[28],[29],[30],[31] Whittaker and Luetje are of the opinion that hearing preservation attempts should be made for tumors below 2 cm in diameter with the patient fully informed. By fully informed means that the patient understands that some hearing may be preserved in 30%-50% of cases (depending on tumor size), and that 30% of this number will have unexplained deterioration later, leaving some permanent hearing impairment; and probably only 7% to 9% of the total group will find hearing useful.[24] This delayed worsening of preserved hearing was observed by Goel et al.[32]

The reported incidence of cerebrospinal fluid leak ranges between 0% and 30%, with the average approximately 12%, although making comparisons between published series is difficult because of the various methods and reporting criteria used by different authors.[33] In the present study 4% (10/250) of patients had cerebrospinal fluid leak with 3 patients requiring surgical repair and the incidence is at par with the series published by Yamakani I et al,[14] recently. However the incidence of associated meningitis in our study is slightly more (8%) as compared to some of the recent series (between 3.7 to 9.2%)[13],[17],[18],[22],[34]

Although loss of cochlear and seventh nerve function are two of the major cranial nerves injuries that can occur during the surgery, there are risks of injury to lower cranial nerves in large and giant sized tumors, which can complicate the post-operative course. Judicious use of nasogastric tube feeding and planned tracheostomy can avoid major respiratory complications post-operatively. The incidence of lower cranial nerve paresis has been reported to range from 1.5% to 5.5%[8],[13],[16],[19] against 6.8% in the present study.

In the present study, all the cases were operated by retro-sigmoid approach with park-bench position, except in 2 patients with sitting position. This concludes the fact that the retro-sigmoid approach in experienced hands is a good option; with good results compared to other series irrespective of the tumor size. This is an extension to the view put forward by Samii et al that from any of the available approaches, such as the sub-occipital, the middle fossa, and the trans-labyrinthine; surgeons can develop expertise to high standards, by training and experience, with respect to the optimum patient's safety, mortality and morbidity.[16]

Gormley and Sekhar et al[9] used the combined transpetrosal and retrosigmoid approach for tumors greater or more than 4 cm in the cerebello-pontine angle, especially when they extend up to the tentorial notch, because the combination allows good visualization of tumor-brain stem interface and the tentorial notch and better facial nerve outcome for these group of tumors. But in our series, using retro-sigmoid approach alone visualization of tumor-brainstem interface and facial nerve preservation could be possible in giant sized tumors with out much difficulty.

 
 » References Top

1.Balasubramaniam V, Ramamurthi B. Experience with auditory neurofibroma. India: Neurol; 1962;10:29.  Back to cited text no. 1    
2.Sambasivan M, Mathai KV, Chandy J. Surgical experience with eighty cases of acoustic neurinomas. India: Neurol; 1966;14:125.  Back to cited text no. 2  [PUBMED]  
3.Ramamurthi B. Acoustic neurinomas in developing countries. International Symposium on Acoustic Neurinomas. India: Neurol; 1990;38:223.  Back to cited text no. 3    
4.Unni M, Rao VRK, Rout D, et al. Common CP angle tumors - A CT analysis. India: Neurol; 1991;39:117.  Back to cited text no. 4    
5.Ramamurthi B. The continuing challenge of acoustic neurinomas (1949-1993). Br J Neurosurg 1995;9:361-6. Review  Back to cited text no. 5    
6.House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146-7.  Back to cited text no. 6  [PUBMED]  
7.Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas). Hearing function in 1000 tumor resections. Neurosurgery 1997;40:248-62.  Back to cited text no. 7    
8.Jackler RK, Pitts LH. Acoustic Neuroma. Neurosurg Clin N Am 1990;1:199-223.  Back to cited text no. 8    
9.Gormley WB, Sekhar LN, Wright DC, Kamerer D, Schessel D. Acoustic neuromas. Results of current surgical management. Neurosurgery 1997;41:50-60.  Back to cited text no. 9    
10.Ojemann RG, Martuza RL. Acoustic neuroma. Youmans JR, Neurological surgery, 3rd Ed. Philadelphia: WB Saunders; 1990. p. 3316-50.  Back to cited text no. 10    
11.Rand RW, Kurze T. Facial nerve preservation by posterior fossa transmaetal microdissection in total removal of acoustic neuroma. J Neurol Neurosurg Psychiatry 1965;28:311-6.  Back to cited text no. 11    
12.Jung S, Kang SS, Kim TS, et al. Current surgical results of retrosigmoid approach in extralarge vestibular schwannoma. Surg Neurol 2000;53:370-7; discussion 377-8.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Lanman TH, Brackmann DE, Hitselberger WE, Subin B. Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. J Neurosurg 1999;90;617-23.  Back to cited text no. 13    
14.Yamakami I, Uchino Y, Kobayashi E, Yamaura A, Oka N. Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neurol Neurosurg Psychiatry 2004;75:453-8.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Ebersold MJ, Harner SG, Beatty CW, Harper CM, Quast LM. Current results of the retromastoid approach to acoustic neurinoma. J Neurosurg 1992;76:901-9.  Back to cited text no. 15    
16.Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): Surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997;40:11-23.  Back to cited text no. 16    
17.Sluyter S, Graamans K, Tulleken CA, et al. Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translybrinthine-transtentorial approach. J Neurosurg 2001;94:61-6.  Back to cited text no. 17  [PUBMED]  
18.Mamikoglu B, Weit RJ, Esquivel CR. Translabrynthine approach for the management of large and giant vestibular schwannomas. Otol Neurotol 2002;23:224-7.  Back to cited text no. 18    
19.Ebersold MJ, Harner SG, Bealty CW, et al. Current results of the retromastoid approach to acoustic neurinomas. J Neurosurg 1992;76:901-9.  Back to cited text no. 19    
20.Tos M, Thomsen J, Harmsen A. Results of translabyrinthine removal of 300 acoustic neuromas related to tumor size. Acta Otolaryngol Suppl 1988;452:38-51.  Back to cited text no. 20  [PUBMED]  
21.Sterkers JM, Morrison GA, Sterkers O, El-Dine MM. Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment. Otolaryngol Head Neck Surg 1994;110:146-55.  Back to cited text no. 21  [PUBMED]  [FULLTEXT]
22.Briggs RJS, Luxford WM, Atkins JS, Hitselberger WE. Translabyrinthine removal of large acoustic neuromas. Neurosurgery 1994;34:785-92.  Back to cited text no. 22    
23.Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): The facial nerve -preservation and restitution of function. Neurosurgery 1997;40:684-95.  Back to cited text no. 23    
24.Whittaker CK, Luetje CM. Vestibular schwannomas. J Neurosurg 1992;76:897-900.  Back to cited text no. 24  [PUBMED]  
25.Cohen NL. Retrosigmoid approach for acoustic tumor removal. Otolaryngol Clin North Am 1992;25:295-310.  Back to cited text no. 25  [PUBMED]  
26.Fischer G, Fischer C, Remond J. Hearing preservation in acoustic neurinoma surgery. J Neurosurg 1992;76:910-7.  Back to cited text no. 26  [PUBMED]  
27.Haines SJ, Levine SC. Intracanalicular acoustic neuroma: Early surgery for preservation of hearing. J Neurosurg 1993;79:515-20.  Back to cited text no. 27  [PUBMED]  
28.Helms J. Hearing preservation in acoustic neurinoma surgery. Otolaryngol Pol 1992;46:533-7.  Back to cited text no. 28  [PUBMED]  
29.Nadol JB Jr, Chiong CM, Ojemann RG, McKenna MJ, Martuza RL, Montgomery WW, et al. Preservation of hearing and facial nerve function in resection of acoustic neuroma. Laryngoscope 1992;102:1153-8.  Back to cited text no. 29  [PUBMED]  
30.Shelton C. Hearing preservation in acoustic tumor surgery. Otolaryngol Clin North Am 1992;25:609-21.  Back to cited text no. 30  [PUBMED]  
31.Slavit DH, Harner SG, Harper CM Jr, Bealty CW. Auditory monitoring during acoustic neuroma removal. Arch Otolaryngol Head Neck Surg 1991;117:1153-7.  Back to cited text no. 31    
32.Goel A, Sekhar LN, Langheinrich W, Kamerer D, Hirsch B. Late course of preserved hearing and tinnitus after acoustic neurlemoma surgery. J Neurosurg 1992;77:685-9.  Back to cited text no. 32  [PUBMED]  
33.Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: Influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg 2001;94:217-23.  Back to cited text no. 33  [PUBMED]  
34.Bryce GE, Nedzelski JM, Rowed DW, et al. Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery. Otolaryngol Head Neck Surg 1991;104:81-7.  Back to cited text no. 34  [PUBMED]  


Figures

[Figure - 1], [Figure - 2]

Tables

[Table - 1], [Table - 2], [Table - 3], [Table - 4]

This article has been cited by
1 Acute presentation of giant sporadic vestibular schwannoma with massive hemorrhage: A critical review with a case illustration
Nitish Nayak, Anil Kumar Sharma, Surendra Kumar Gupta, Prashant Raj Singh
Brain and Spine. 2022; 2: 100897
[Pubmed] | [DOI]
2 Surgical Outcomes After Total or Subtotal Resection of Large Vestibular Schwannoma: A Single-Institution Experience
Sujin Rujimethapass, Anant Ananthanandorn, Krissanee Karnchanapandh, Mathee Wongsirisuwan, Ittipon Gunnarat, Noppatee Segkhaphant
Brain Tumor Research and Treatment. 2022; 10(2): 108
[Pubmed] | [DOI]
3 Surgical Outcome of Giant Vestibular Schwannomas: A Retrospective Analysis
Mohamed I. Refaat, Omar Y. Abdallah
Indian Journal of Neurosurgery. 2021;
[Pubmed] | [DOI]
4 Progressive Vestibular Schwannoma following Subtotal or Near-Total Resection: Dose-Escalated versus Standard-Dose Salvage Stereotactic Radiosurgery
Mohamed H. Khattab, Alexander D. Sherry, Nauman Manzoor, Douglas J. Totten, Guozhen Luo, Lola B. Chambless, Alejandro Rivas, David S. Haynes, Anthony J. Cmelak, Albert Attia
Journal of Neurological Surgery Part B: Skull Base. 2021; 82(S 03): e9
[Pubmed] | [DOI]
5 The incidence of postoperative cerebrospinal fluid leakage after elective cranial surgery: a systematic review
Birgit Coucke, Lura Van Gerven, Steven De Vleeschouwer, Frank Van Calenbergh, Johannes van Loon, Tom Theys
Neurosurgical Review. 2021;
[Pubmed] | [DOI]
6 Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section
Daniele Starnoni, Lorenzo Giammattei, Giulia Cossu, Michael J. Link, Pierre-Hugues Roche, Ari G. Chacko, Kenji Ohata, Majid Samii, Ashish Suri, Michael Bruneau, Jan F. Cornelius, Luigi Cavallo, Torstein R. Meling, Sebastien Froelich, Marcos Tatagiba, Albert Sufianov, Dimitrios Paraskevopoulos, Idoya Zazpe, Moncef Berhouma, Emmanuel Jouanneau, Jeroen B. Verheul, Constantin Tuleasca, Mercy George, Marc Levivier, Mahmoud Messerer, Roy Thomas Daniel
Acta Neurochirurgica. 2020; 162(11): 2595
[Pubmed] | [DOI]
7 Complications and Management of Large Intracranial Vestibular Schwannomas Via the Retrosigmoid Approach
Xiang Huang,Ming Xu,Jian Xu,Liangfu Zhou,Ping Zhong,Mingyu Chen,Kaiyuan Ji,Huiyu Chen,Ying Mao
World Neurosurgery. 2017; 99: 326
[Pubmed] | [DOI]
8 Functional outcome and complications after the microsurgical removal of giant vestibular schwannomas via the retrosigmoid approach: a retrospective review of 16-year experience in a single hospital
Xiang Huang,Jian Xu,Ming Xu,Mingyu Chen,Kaiyuan Ji,Junwei Ren,Ping Zhong
BMC Neurology. 2017; 17(1)
[Pubmed] | [DOI]
9 Patient- versus physician-reported facial disability in vestibular schwannoma: an international cross-sectional study
Řystein Vesterli Tveiten,Matthew L. Carlson,Frederik Goplen,Erling Myrseth,Colin L. W. Driscoll,Rupavathana Mahesparan,Michael J. Link,Morten Lund-Johansen
Journal of Neurosurgery. 2017; 127(5): 1015
[Pubmed] | [DOI]
10 Morphometric analysis of posterior fossa in Indian CP angle acoustic schwannoma patients
MohanaRao Patibandla,ManasK Panigrahi,PanirajL Gurram,AmitKumar Thotakura,Dilip Kulkarni
Asian Journal of Neurosurgery. 2016; 11(3): 255
[Pubmed] | [DOI]
11 A STUDY OF THE INCID ENCE OF CEREBELLOPON TINE ANGLE TUMORS AND THEIR MAN AGEMENT IN A TERTIAR Y CARE HOSPITAL
Raja Sekhar Kennedy G, Jagadish Jagadish
Journal of Evidence Based Medicine and Healthcare. 2015; 2(17): 2517
[Pubmed] | [DOI]
12 Contemporary Surgical Management of Vestibular Schwannomas
Yoichi Nonaka,Takanori Fukushima,Kentaro Watanabe,Allan H. Friedman,John H. Sampson,John T. Mcelveen,Calhoun D. Cunningham,Ali R. Zomorodi
Neurosurgery. 2013; 72: ons103
[Pubmed] | [DOI]
13 Cerebellopontine angle meningiomas: postoperative outcomes in a modern cohort
Vijay Agarwal,Ranjith Babu,Jordan Grier,Owoicho Adogwa,Adam Back,Allan H. Friedman,Takanori Fukushima,Cory Adamson
Neurosurgical Focus. 2013; 35(6): E10
[Pubmed] | [DOI]
14 Large and giant vestibular schwannomas: does cisterna magna hyperproteinorrhachia influence visual status?
Brijesh Kumar,Sanjay Behari,Awadhesh K. Jaiswal,Vikas K. Jha,Guruprasadh Bettaswamy,Uttam Singh
Acta Neurochirurgica. 2013; 155(1): 63
[Pubmed] | [DOI]
15 Functional outcome and postoperative complications after the microsurgical removal of large vestibular schwannomas via the retrosigmoid approach: a meta-analysis
Peng Zou,Lin Zhao,Ping Chen,Haitao Xu,Ning Liu,Peng Zhao,Ailin Lu
Neurosurgical Review. 2013;
[Pubmed] | [DOI]
16 Facial nerve function after large cystic vestibular schwannomas surgery via the retrosigmoid approach
Wang, M. and Jia, D. and Shen, J. and Zhang, J. and Li, G.
Turkish Neurosurgery. 2013; 23(2): 161-169
[Pubmed]
17 Large and giant vestibular schwannomas: Does cisterna magna hyperproteinorrhachia influence visual status?
Kumar, B. and Behari, S. and Jaiswal, A.K. and Jha, V.K. and Bettaswamy, G. and Singh, U.
Acta Neurochirurgica. 2013; 155(1): 63-69
[Pubmed]
18 Giant vestibular schwannomas
Gerganov, V.M. and Samii, M.
World Neurosurgery. 2012; 77(5-6): 627-628
[Pubmed]
19 Giant Vestibular Schwannomas
Venelin M. Gerganov,Madjid Samii
World Neurosurgery. 2012; 77(5-6): 627
[Pubmed] | [DOI]
20 Surgical Removal of Giant Acoustic Neuromas
Joana Silva, Antrintónio Cerejo, Filipe Duarte, Fernando Silveira, Rui Vaz
World Neurosurgery. 2011;
[VIEW] | [DOI]
21 Decision analysis of treatment options for vestibular schwannoma : Clinical article
Robert G. Whitmore, Christopher Urban, Ephraim Church, Michael Ruckenstein, Sherman C. Stein, John Y. K. Lee
Journal of Neurosurgery. 2011; 114(2): 400
[VIEW] | [DOI]
22 Beyond audiofacial morbidity after vestibular schwannoma surgery : Clinical article
Michael E. Sughrue, Isaac Yang, Derick Aranda, Martin J. Rutkowski, Shanna Fang, Steven W. Cheung, Andrew T. Parsa
Journal of Neurosurgery. 2011; 114(2): 367
[VIEW] | [DOI]
23 Functional outcome after complete surgical removal of giant vestibular schwannomas
Madjid Samii,Venelin M. Gerganov,Amir Samii
Journal of Neurosurgery. 2010; 112(4): 860
[Pubmed] | [DOI]
24 Muscle-flap salvage of prosthetic dural repair
Connie Chung,Antonio J.V. Forte,Reza Momeni,Quratulain Fatima Masood,Deepak Narayan
Journal of Plastic, Reconstructive & Aesthetic Surgery. 2010; 63(2): 213
[Pubmed] | [DOI]
25 Functional outcome after complete surgical removal of giant vestibular schwannomas
Samii, M., Gerganov, V.M., Samii, A.
Journal of Neurosurgery. 2010; 112(4): 860-867
[Pubmed]
26 Muscle-flap salvage of prosthetic dural repair
Chung, C., Forte, A.J.V., Momeni, R., Fatima Masood, Q., Narayan, D.
Journal of Plastic, Reconstructive and Aesthetic Surgery. 2010; 63(2): 1-2
[Pubmed]
27 Analysis of causes for late presentation of Indian patients with vestibular schwannoma
R Ambett, V Rupa, V Rajshekhar
The Journal of Laryngology & Otology. 2009; 123(5): 502
[VIEW] | [DOI]
28 Management strategies for bilateral vestibular schwannomas
Rabi N. Sahu,N. Mehrotra,I. Tyagi,Deepu Banerji,V.K. Jain,Sanjay Behari
Journal of Clinical Neuroscience. 2007; 14(8): 715
[Pubmed] | [DOI]
29 Pediatric vestibular schwannoma with or without neurofibromatosis: Characteristic features and operative nuances
Garg, P., Behari, S., Jaiswal, S., Jaiswal, A., Jain, V., Mahapatra, A.
Journal of Pediatric Neurosciences. 2007; 2(2): 1-2
[Pubmed]
30 Management strategies for bilateral vestibular schwannomas
Sahu, R.N., Mehrotra, N., Tyagi, I., Banerji, D., Jain, V.K., Behari, S.
Journal of Clinical Neuroscience. 2007; 14(8): 715-722
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow