Functional microsurgery of vestibular schwannomas

Abstract

The introduction of the operating microscope into otorhinolaryngology in the 1960s and into neurosurgery in 1968 [ 22 ] meant a breakthrough for these disciplines and brought about a fundamental change in patients‘ chances of survival in general and specifi cally in skull base surgery. Rates of morbidity were signifi cantly improved by microsurgery [ 2, 31 ], but a functional mode of performing neurosurgery of skull base lesions still needed to be developed 10-20 years later by implementing neuromonitoring [ 4, 5, 21 ]. Vestibular schwannomas constitute the most frequent pathology of the cerebellopontine angle affecting mostly patients of middle age, but become symptomatic virtually at all age classes. Under ideal conditions, VS can be cured, i.e. They may be removed completely with a risk of recurrence below 0.1 % [ 28 ], with completely intact neurological function and no subjective complaints. Due to the nature and location of VS, however, the majority of patients are threatened by facial palsy and vestibular and auditory dysfunction. As an alternative to any kind of treatment, the option of “wait and scan” is repeatedly discussed by numerous colleagues. Several studies documented a continuous or sudden decline of auditory function and fi nally deafness within a period of 9-14 years [ 34 ]. At this aspect microsurgical resection must be considered in time if functional hearing preservation is an important goal.