Clinical Outcome of Consecutive Surgical Series of 100 Vestibular Schwannomas

Objectives: It is important to preserve neurological function and good quality of life in managing vestibular schwannomas. Outcome of consecutive surgical series by a single surgeon and factors affecting outcome are analyzed.

Material and Method: One hundred cases with vestibular schwannomas have been treated for the last 8 years with median follow-up of 36 months. Mean age was 49, and the mean tumor size was 26 mm (range, 7 to 70 mm). Tumors were grouped by the Koos classification into Grades I (10), II (35), III (33), and IV (24). There were 8 NF II cases. Surgical approaches were retrosigmoid in 82 and translabyrinthine or petrosal approach in 20 cases. In 47 cases, preoperative hearing was serviceable (Gardner-Robertson A or B).

Result: Total or near-total resection was achieved in 80 cases (80%). Facial nerve function (House-Brackmann I, II) was preserved in 100% in Koos I, II; 93.7% in III; and 86% in IV. Postoperative serviceable hearing was preserved in 75% in Koos I, II; 36% in III; and 20% in IV. There was significant difference in the outcome of hearing preservation between earlier versus later in surgical experience.

Conclusion: Surgical experience, the size and distribution of the tumor mass, and the nature of tumor capsule influenced the surgical outcome of vestibular schwannomas.