Surgical Management of Vestibular Schwannomas in Neurofibromatosis Type 2

• Main Authors: Tysome, J. R., MacFarlane, R., Durie-Gair, J., Donnelly, N., Mannion, R., Knight, R., Harris, F., Vanat, Z. H., Tam, Y. C., Hensiek, A., Raymond, F. L., Moffat, D. A., Axon, P. R.
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0032-1314192

Objectives: To report our approach to the surgical management of vestibular schwannomas (VSs) and hearing rehabilitation in neurofibromatosis type 2 (NF2). Design: Retrospective cohort study in a tertiary referral NF2 unit. Patient/Materials and Methods: Seventy-five patients were managed in our NF2 unit. Hearing and NF2 mutation were evaluated in all current patients. Patients who underwent VS excision were evaluated for tumor size, surgical approach, and outcomes of hearing and facial nerve function. Results: Of 50 VSs excised in our unit, 14% had facial neuroma excision and reinnervation during the same operation. At 12 months after surgery, facial nerve outcomes were House-Brackmann (HB) 1 in 33%, HB 2 in 21%, and HB 3 in 30%. Total VS resection was achieved in 78% of patients using a translabyrinthine approach. Seventy-two percent of current patients have AAO-HNS class A-C hearing (maximum SDS over 50%) in the better hearing ear, and a further 14% are full-time users of cochlear implants (CI) or auditory brainstem implants (ABI). The remaining patients have been assessed for auditory implantation. Conclusions: By following a policy of treating VSs in NF2 patients where tumor growth is observed, complete tumor resection can be achieved through a translabyrinthine approach while achieving comparable facial nerve outcomes to published series. We advocate proactive hearing rehabilitation in all patients with timely assessment for auditory implantation to maintain quality of life.