| Abstrakt: |
Vestibular schwannomas are uncommon, benign intracranial tumors that present a management challenge based on their intimate association with the brainstem and the cranial nerves affecting hearing and facial nerve function. Modern strategies for managing vestibular schwannomas have been characterized by improved diagnostic accuracy and reduced morbidity and mortality rates. Observation with serial imaging, open microsurgical tumor resection, stereotactic radiosurgery, or a combination of both modalities represent viable management options. Treatment should be individualized based on the unique characteristics and expectations of each patient. Vestibular schwannomas are associated with hearing and balance deficits due to compression of the brainstem and vestibulocochlear nerve. Magnetic resonance imaging is used for definitive diagnosis, and computed tomography as well as audiometry are generally used as part of patient evaluation. Open microsurgery, which was previously regarded as the mainstay of therapy, is associated with relatively high rates of hearing loss, facial nerve injury, cerebrospinal fluid leakage, and damage to neural structures when compared to stereotactic radiosurgery. As a result, stereotactic radiosurgery has become a critical treatment option for older patients, for those with medical co-morbidities, and for younger patients with good preoperative hearing function. Younger patients with very large tumors resulting in significant brainstem compression still generally require open surgery to decompress the brainstem. In our experience, many such patients will benefit from a combined approach including debulking of the tumor to decompress the brainstem followed by radiosurgery to treat residual tumor adherent to critical structures. As surgical approaches for vestibular schwannoma have improved, most patients undergoing treatment can expect reasonable preservation rates of both hearing and facial nerve function. Optimal care should be determined on an individualized, case-by-case basis, may involve a combined surgical/radiosurgical approach, and should ideally be delivered in high volume, multi-disciplinary centers. [ABSTRACT FROM AUTHOR] |
