Surgical Resection For The Treatment Of Patients With Vestibular Schwannomas
Publication Date: February 1, 2018
Last Updated: March 14, 2022
RECOMMENDATIONS
There is insufficient evidence to support the superiority of either the middle fossa (MF) or the retrosigmoid (RS) approach for complete VS resection and FN preservation when serviceable hearing is present.
6731
There is insufficient evidence to support the superiority of either the RS or the TL approach for complete VS resection and FN preservation when serviceable hearing is not present.
6731
Patients with larger VS tumor size should be counseled about the greater than average risk of loss of serviceable hearing.
(Level 3 Evidence)
6731
There are insufficient data to support a firm recommendation that surgery be the primary treatment for this subclass of VSs.
6731
Hearing preservation surgery via the MF or the RS approach may be attempted in patients with small tumor size (<1.5 cm) and good preoperative hearing.
(Level 3 Evidence)
6731
There is insufficient evidence that surgical resection should be the initial treatment in patients with NF2.
6731
There is insufficient evidence to support stating that a multidisciplinary team, usually consisting of a neurosurgeon and a neurotologist, provides superior outcomes compared to either subspecialist working alone.
6731
There is insufficient evidence to support subtotal resection (STR) followed by SRS provides comparable hearing and FN preservation to patients who undergo a complete surgical resection.
6731
There is insufficient evidence to support either surgical resection or SRS for treatment of preoperative balance problems.
6731
Surgical resection of VSs may be used to better relieve symptoms of trigeminal neuralgia than SRS.
(Level 3 Evidence)
6731
If microsurgical resection is necessary after SRS, it is recommended that patients be counseled that there is an increased likelihood of a STR and decreased FN function.
(Level 3 Evidence)
6731
Recommendation Grading
Overview
Title
Surgical Resection for the Treatment of Patients with Vestibular Schwannomas
Authoring Organization
Congress of Neurological Surgeons
Publication Month/Year
February 1, 2018
Last Updated Month/Year
August 7, 2023
Document Type
Guideline
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room
Intended Users
Physician, nurse, nurse practitioner, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D015837 - Vestibular Diseases, D009464 - Neuroma, Acoustic
Keywords
acoustic neuroma, Surgical resection, Neurofibromatosis type 2, Stereotactic radiosurgery, vestibular schwannoma
Supplemental Methodology Resources
Methodology
Number of Source Documents
164
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 31, 2014