11 Results and Summary
Results
Summary
Results
Our main intention in this atlas has been to provide as much visual material as possible within the restrictions of a one-volume book. As in a typical atlas, the text has been reduced to an absolute minimum – but the work would not be complete without an outline of the main results of the treatments described, at least with regard to basic parameters such as morbidity and mortality rates, and details of postoperative facial nerve function and hearing preservation.
The overriding goal in all cases is clearly to remove all of the tumor without giving rise to additional deficits, and this target requires surgical results that are at the highest possible level. In cases of grade 1 and 2 tumors treated using the techniques described here, this goal can be achieved in about 95 % of patients. In patients with grade 3 tumors, it can be achieved in about 70 %, and even in those with grade 4 tumors, it is possible in more than 50 % of cases. In our series during the last 20 years, we have treated small tumors (grades 1 and 2) in about 25 % of cases and large tumors (grades 3 and 4) in about 75 % (Tables 11.1, 11.2.)
Intraoperative and perioperative mortality rates were zero. The overall mortality rate has been less than 0.5 %.
Perioperative morbidity is generally very low (meningitis in around 5 %, cerebrospinal fluid leak in less than 3.5 %, cerebrovascular accidents in 0.5 %, and requirement for further shunt procedures or endoscopic ventriculostomy in about 5 %).
Preservation of facial nerve function (Fig. 11.1). In all cases (grades 1 – 4), we have observed full facial nerve function in 82 % of cases 1 week postoperatively and in 91 % of cases 12 – 18 months postoperatively. Partial function has been noted in 16 % of cases 1 week postoperatively and in 7 % 12 – 18 months postoperatively. When there is no postoperative function, generally seen in 2 % Of cases 1 week postoperatively, the condition remains the same after 12 – 18 months.
Hearing preservation (Figs. 11.2, 11.3). In patients with small tumors (grades 1 and 2), we have observed a preoperative hearing rate of 86 % and a postoperative hearing preservation rate of 74 %. In patients with large tumors (grades 3 and 4), the preoperative hearing rate was 18 % and the postoperative rate 10 %.
Treatment options. With regard to comparisons between the two main treatment options, microsurgery and radiosurgery, standard parameters have been summarized in Table 11.3 to allow an objective background for discussion.
Table 11.1 The main criteria used in surgery for acoustic neurinomas (n=687) at the Department of Neurosurgery at the University of Vienna between 1970 and 2000, divided into two periods.
Type | Group 1 (1970–79) (n = 137) | Group 2 (1980–2000) (n = 550) |
|---|---|---|
Small tumors | (Grade 2) 9 % (12 patients) | (Grades 1 and 2) 25 % (142 patients) |
Large tumors | (Grades 3 and 4) 91 % (125 patients) Long history, late diagnosis | (Grades 3 and 4) 75 % (408 patients) Shorter history, earlier diagnosis (CT, MRI; specific cochlear and vestibular tests) |
Surgical mortality rate 4% | 0.5 % |
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