Int. Adv. Otol. 2010; 6(2); 141-148

The tumor size and foramen Luschka in vestibular schwannoma surgery
Juraj Koval, Silvia Krempaská
University of P.J. Šafarik,  Košice, Slovakia

Objective: The aim of this work is to document how the situation in the foramen Luschka region influences our indication of translabyrinthine and retrosigmoid approaches in the treatment of vestibular schwannoma and other problems in thepontocerebellar space.

Material and Methods: Retrospective review of postoperative convalescence of 75 patients operated by translabyrinthine approach for a big vestibular schwannoma, which according to NMR imaging blocks the foramen Luschka, out of all series of 151 patients, 45 vestibular schwannoma patients operated elsewhere by suboccipital approach and 15 patients operated by minimum retrosigmoid approach for various neurootologic problems is presented. Translabyrinthine and suboccipital surgery were performed in 1996 to 2007. The shortest duration of the follow up time was one year. Minimum retrosigmoid surgery was performed in 2008 - 2009; the shortest follow up time was 6 months.

Results: Balance functions after translabyrinthine removal of big tumours (75 patients): after 2 months - mild instability 69 and moderate instability 6 patients, after 1 year mild instability when tired 18 patients. Balance functions - retractor disease after suboccipital removal of medium and big tumours (45 patients) after 1 year and longer: severe instability 28, moderate instability 11, mild instability 6, meatus not opened and residuum growing 7 patients. Balance functions after minimum retrosigmoid approach for various diseases (15 patients): balance problem after 2 months - no patient.

Conclusion: In case of vestibular schwannoma 2 cm<, when the foramen Luschka is usually blocked with a tumour, translabyrinthine approach is chosen. In the case of tumours >2 cm, if there is not any hearing category A, B, C translabyrinthine approach is chosen. In the case of tumours <1,5 cm fulfilling the criteria for possible preservation of hearing retrosigmoid approach is chosen. The group of tumours 1,5cm ? 2,5 cm is the group where the shift in the indication of the surgery is possible, it is based on a surgeon´s experience and preference.