• World Neurosurg · Jan 2025

    A 25 Year Update on the Facial Nerve Sparing Approach for Vestibular Schwannoma.

    • Jonathan A Sisti, Mychael W Delgardo, Nina Yoh, Ogoegbunam B Okolo, Pavan S Upadhyayula, Andrés Pascual-Leone, Catherine R Paccione, WangTony J CTJCDepartment of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA, 10032; Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA, 10032., and Michael B Sisti.
    • Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA, 10032.
    • World Neurosurg. 2025 Jan 2: 123603123603.

    Background And ObjectivesThis article aims to report results of our facial nerve preservation approach to treating vestibular schwannomas (VS) at a single institution by a single surgeon performing both microsurgery (MS) and stereotactic radiosurgery (SRS).MethodsWe retrospectively reviewed 751 patients at our institution between 1998 and 2023 by intervention received: retrosigmoid microsurgery (MS, Group 1, 217 patients), gamma knife stereotactic radiosurgery (SRS, Group 2, 462 patients), MS then SRS (Group 3, 72 patients), SRS then MS (Group 4, 10 patients), and SRS then SRS (Group 5, 5 patients). No patients had MS followed by MS. The primary outcome variable was postoperative facial nerve function.ResultsGood outcomes (defined as House-Brackmann grade ≤2 at last follow-up) across treatment groups were 98.2%, 99.6%, 93.1%, 90%, and 100%, respectively, with 96.9% and 99.4% of patients treated with upfront MS and upfront SRS, respectively, having a good outcome. For groups who received more than one treatment (3, 4, 5), the mean time between treatment and progression was 48.8, 35.7, and 95.8 months, respectively. No patients underwent additional treatment following salvage treatment. The median (IQR) follow-up time among patients with a minimum follow-up of 12 months was 52 (26.75-88) months, with a maximum of 297 months (24.75 years).ConclusionsFor patients with VS not undergoing primary SRS, MS with an emphasis on facial-nerve preservation over gross total resection followed by surveillance imaging and adjuvant SRS is an effective treatment paradigm that yields excellent facial nerve outcomes, low morbidity, and acceptable tumor control.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…