Initial Surgical Outcomes for Vestibular Schwannoma in the Era of Less Hands-on Training

• Main Authors: Milligan, Brian, Ursick, Joseph, Cullen, Robert, Thedinger, Bradley
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0035-1546486

Introduction: Patients and the public are increasingly demanding attending oversight of trainees and asking for surgeon-specific outcome statistics before choosing a surgeon. Teaching physicians are forced to decide whether to perform more of the critical portion themselves, potentially sacrificing training, or to allow trainees to do so, potentially sacrificing outcome/quality. The purpose of this study is to understand surgeon readiness to perform what they have only observed before starting practice. Methods: The first 34 patients treated surgically by this author posttraining (September 2012–July 2014) for a unilateral, spontaneous vestibular schwannoma (VS) comprised the study group. The indication for surgical treatment versus SRS/Observation included severe headaches or cranial neuropathy, young age, uncertainty regarding the affordability of MRI follow-up, and patient preference. Overall, 10 (29%) tumors were intracanalicular. For tumors extending into the cerebellopontine angle (CPA), the median maximum CPA tumor dimension was 15 mm (range, 7–36 mm). All patients presented with excellent facial nerve function (HB I/II) Results: A gross or near-total removal was achieved in 91%, and 82% had an excellent facial nerve function at last follow-up (median 6.3 months). Delayed facial weakness was common (53%). Hearing preservation was successful in 71% of attempts ( n = 5/7). The median available follow-up was short due to the practice of this group; several early follow-ups (< 6 months) before delayed follow-up/MRI (18–24 months). While 50% of cases logged by the neurosurgeon as a resident or skull-base fellow were cranial, he performed no critical dissection on any of the 30 VS resections logged. Conclusion: Although newly trained complex cranial surgeons may not perform a complete VS resection before finishing the training, our initial operative experience demonstrates that outcomes comparable to those described by experienced authors are possible in the modern training era.