Our Summary

This research paper is a detailed review of the many medical studies that have been conducted on the treatment of vestibular schwannomas (VS), which are benign (non-cancerous) tumors that grow on the nerve responsible for hearing and balance. The treatment method analyzed in this review is the retrosigmoid (RS) approach, a type of surgery that allows doctors to remove these tumors while possibly preserving the patient’s hearing.

The authors of this paper searched through three databases of medical literature, looking for studies that detailed both the hearing levels of patients before and after undergoing this surgery. They found 26 studies that met their criteria, which included data on over 2,000 patients.

They found that the overall rate of successful hearing preservation was between 31% and 35%, depending on how they calculated the numbers. More interestingly, they found that the chances of preserving hearing varied depending on how large the tumor was before surgery. Specifically, the chances of preserving hearing were 57% for tumors within the ear canal, 37% for small tumors (up to 20mm), and just 12% for larger tumors (over 20mm).

However, there was a lot of variation between different studies, with some studies reporting a 0% success rate and others reporting a 100% success rate. This suggests that other factors beyond just tumor size could be important.

In conclusion, the authors suggest that while tumor size appears to affect the odds of preserving hearing, many other factors need to be considered when deciding on a treatment plan. It’s crucial to discuss the patient’s expectations and potential outcomes before deciding on a course of action.

FAQs

  1. What is a vestibular schwannoma and how is it treated?
  2. How does the retrosigmoid surgical approach potentially preserve postoperative hearing in patients with vestibular schwannoma?
  3. How does tumor size affect hearing preservation rates in patients treated with the retrosigmoid approach for vestibular schwannoma?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy for vestibular schwannoma treatment is to discuss expectations for hearing preservation. Tumor size can impact hearing preservation rates, so it is important to have a thorough conversation with your healthcare provider about the potential outcomes and risks associated with the surgery. Additionally, follow-up care and rehabilitation may be necessary to optimize hearing outcomes postoperatively.

Suitable For

Patients with vestibular schwannomas (VS) who have serviceable preoperative hearing are typically recommended for craniotomy, specifically the retrosigmoid (RS) approach, in order to potentially preserve postoperative hearing. Tumor size may also play a role in determining the likelihood of hearing preservation, with smaller tumors having higher preservation rates compared to larger tumors. It is important for healthcare providers to discuss a patient’s expectations for hearing preservation when deciding on treatment plans for VS.

Timeline

Before craniotomy:

  • Patient is diagnosed with vestibular schwannoma (VS) through imaging studies or symptoms such as hearing loss, tinnitus, balance issues, or facial numbness.
  • Patient undergoes preoperative evaluation to assess hearing status and other relevant medical factors.
  • Treatment options, including the retrosigmoid (RS) surgical approach, are discussed with the patient and a treatment plan is decided upon.
  • Patient undergoes preoperative preparation and counseling to understand the procedure and potential outcomes.

After craniotomy:

  • Patient undergoes the RS surgical approach to resect the vestibular schwannoma.
  • Postoperative monitoring and recovery take place in the hospital, with regular assessments of neurological function and hearing status.
  • Patient may experience temporary symptoms such as headache, dizziness, nausea, or facial weakness as they recover from surgery.
  • Long-term follow-up appointments are scheduled to monitor for tumor recurrence and assess hearing preservation outcomes.
  • Patient may undergo rehabilitation or additional treatment as needed to manage any persistent symptoms or complications.

What to Ask Your Doctor

  1. What is the purpose of a craniotomy in treating my condition?
  2. What are the potential risks and complications associated with a craniotomy procedure?
  3. How long is the recovery period after a craniotomy and what can I expect during this time?
  4. Will I experience any changes in my hearing or other sensory functions after the procedure?
  5. How likely is it that my hearing will be preserved after the craniotomy?
  6. Are there any alternative treatment options available for my condition?
  7. What are the long-term effects of a craniotomy on my overall health?
  8. How many craniotomies have you performed for this specific condition and what is your success rate?
  9. What follow-up care will I need after the craniotomy procedure?
  10. Are there any lifestyle changes or precautions I should take after the surgery to support my recovery?

Reference

Authors: Preet K, Ong V, Sheppard JP, Udawatta M, Duong C, Romiyo P, Nguyen T, Kwan I, Yang I. Journal: Neurosurgery. 2020 Mar 1;86(3):332-342. doi: 10.1093/neuros/nyz147. PMID: 31149722