Cranial nerve preservation in contemporary vestibular schwannoma (acoustic neuroma) treatment

Comparison of Cranioplasty Techniques Following Translabyrinthine Surgery: Implications for Postoperative Pain and Opioid Usage

OBJECTIVE

To assess differences in postoperative pain, opioid usage, and surgical outcomes between cranioplasty using abdominal fat graft (AFG) versus hydroxyapatite cement (HAC) following translabyrinthine surgery.

STUDY DESIGN

Retrospective case control.

SETTING

Tertiary referral center.

PATIENTS

Sixty translabyrinthine procedures were evaluated, including 30 consecutive HAC patients and 30 matched AFG patients. Patients were matched by age, gender, body mass index, and tumor size.

INTERVENTION

Cranioplasty using HAC or AFG following translabyrinthine resection of vestibular schwannoma.

MAIN OUTCOME MEASURES

Postoperative patient pain ratings, narcotic usage, inpatient length of stay, and complication rates.

RESULTS

Patients who underwent HAC cranioplasty had lower postoperative pain scores on several measures (p < 0.05) and less postoperative narcotic usage (mean difference of 36.7 morphine equivalents, p = 0.0025) when compared to those that underwent AFG closure. HAC cranioplasty patients had shorter average length of hospital stay (2.2 vs 3.4 days, p = 0.0441). Postoperative cerebrospinal fluid leaks (one in HAC group, two in AFG group) and skin reactions in AFG closure patients (n = 1) were infrequent.

CONCLUSION

HAC cranioplasty is a safe technique comparable to AFG closure following translabyrinthine surgery which can decrease postoperative pain, narcotic usage, and hospital length of stay.

Stereotactic radiotherapy for vestibular schwannoma

BACKGROUND

Vestibular schwannomas (acoustic neuromas) are common benign tumours that arise from the Schwann cells of the vestibular nerve. Management options include observation with neuroradiological follow-up, microsurgical resection and stereotactic radiotherapy.

OBJECTIVES

To assess the effect of stereotactic radiotherapy compared to observation, microsurgical resection, any other treatment modality, or a combination of two or more of the above approaches for vestibular schwannoma.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; Web of Science; CAB Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 24 July 2014.

SELECTION CRITERIA

Randomised controlled trials (RCTs) exploring the efficacy of stereotactic radiotherapy compared with observation alone, microsurgical resection or any other possible treatment or combination of treatments in patients with a cerebellopontine angle tumour up to 3 cm in diameter, presumed to be a vestibular schwannoma.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS

No studies met the inclusion criteria for this review.

AUTHORS' CONCLUSIONS

There is no high quality evidence in the literature from RCTs to determine whether stereotactic radiotherapy is better than microsurgical resection or observation alone for patients with a vestibular schwannoma. In the absence of such evidence, the treatment method should be chosen on an individual basis, taking into consideration the patient's preferences, clinician experience and the availability of radiotherapeutic equipment. With the growing availability of radiotherapeutic equipment, randomised controlled trials should be undertaken to evaluate the role of stereotactic radiotherapy in comparison with other treatment options.

Treatment of cerebellopontine angle tumors in children: a single institution's experience

The authors discuss the current management for cerebellopontine angle (CPA) tumors in children. CPA tumors accounted for 1% to 3% of intracranial tumors in children. There had been much controversy with the management of these tumors. A total of 29 eligible patients were enrolled to the study and 5 patients had multiple lesions at diagnosis. Eight patients with tumors exclusively confined in the CPA. Sixteen patients with tumors occurred predominantly within CPA and 5 arising from the vicinity and growing mainly into the CPA. Twelve tumors were located in the right CPA (41%) and 5 (17%) on the left. Thirteen of the 29 patients developed hydrocephalus and 3 required placement of a shunt. Lesions of the CPAs were divided into those native to the angle and those extending to the angle from adjacent structures. Gross total removal was achieved in 9 cases, subtotal in 14, and 2 had biopsies only. Four patients were diagnosed with pontine glioma solely by magnetic resonance imaging without histologic confirmation. Two died soon after the operation. Ten patients died with a mortality rate of 34.5%. The median follow-up in this study was 38 months (range: 4 to 225 mo). The CPA is a rare location for lesions in children, with clear predominance on the right side. Although low-grade lesions are more frequent, the histology varies widely and is limited by the lack of radiologic-pathologic correlation.