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Editorial
5 (
3
); 209-209
doi:
10.4103/0976-3147.133549

Staging in giant vestibular Schwannoma surgery

Address for correspondence: Dr. Alvaro Campero, Country Las Yungas, Tucumán, Argentina E-mail: alvarocampero@yahoo.com.ar
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher; therefore Scientific Scholar has no control over the quality or content of this article.

Source of Support: Nil.

Conflict of Interest: None declared.

In the manuscript titled “Staging in giant vestibular Schwannoma surgery: A two consecutive day technique for complete resection in basic neurosurgical setups,”[1] the authors have represented 12 cases of giant vestibular Schwannomas surgically treated in the Bangur Institute of Neurosciences through a retrosigmoid approach in two stages on two consecutive days after a night in the intensive care unit. They have observed that this technique improves tumor resection for surgeon comfort without major surgical risks in hospitals with basic technology.

Despite the fact that there are many research papers published in the literature about long series with giant vestibular Schwannomas resected in one step,[2345] it could be an option for hospitals without the latest technological envelope. However, we think the study could be improved with a control group (patients with complete resection in one step in the same conditions) versus two steps in order to clarify its value. Furthermore, we do not advocate the routine use of ventriculoperitoneal shunt 1 week before the surgical resection because the management of cerebrospinal fluid can be controlled using external ventriculostomy during surgery without permanent shunt.

In addition, we would like to emphasize that the goal of giant vestibular Schwannoma surgery is radical removal with preservation of facial and lower cranial nerve function; therefore, intraoperative monitoring is necessary to use, and this technique is not related to maintaining facial nerve function, which worsened after surgery and subsequently improved with passing of months. As the authors suggested, further research with longer follow-up as well as with a larger number of patients should be carried out in order to demonstrate the efficaciousness of giant vestibular Schwannoma surgical resection in two steps for these kinds of hospitals.

References

  1. , , , . Staging in giant vestibular schwannoma surgery: A two consecutive day technique for complete resection in basic neurosurgical setups. J Neurosci Rural Pract. 2014;5:225-30.
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  2. , , , , , , . Functional outcome and postoperative complications after the microsurgical removal of large vestibular schwannomas via the retrosigmoid approach: A meta-analysis. Neurosurg Rev. 2014;37:15-21.
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  3. , , . Technical nuances of resection of giant (>5 cm) vestibular schwannomas: Pearls for success. Neurosurg Focus. 2012;33:E15.
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  4. , , , , . Dural landmark to locate the internal auditory canal in large and giant vestibular schwannomas: The Tübingen line. Neurosurgery. 2011;69(Suppl Operative1):Ons99-102.
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  5. , , , . Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg. 2010;112:860-7.
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