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Introduction. A vestibular schwannoma (also known as acoustic neuroma) is a tumor developing from the schwann cells of the VIII cranial nerve. On average, 10% of intracranial tumors are accounted for vestibular schwannomas. Neuromas are slow-growing tumors, according to the Koos classification system there are 4 grades of tumors. Asymptomatic neuromas, measuring up to 1,5 сm, now because of the widespread use of MRI are diagnosed more often, which allows specialized monitoring and intervention if necessary. Treatment strategies for these tumors are still under dispute one of the new proposed options for possible treatment is neuroma excision while awake using the assessment of acoustically evoked potentials (AEPs), which provides dual control over the function of both the vestibulocochlear nerve, as well as facial and trigeminal nerves (Spontaneous Potentials, Trigger Potentials). In addition, if the group of caudal nerves is involved, their control is also possible, thereby increasing the chances of maintaining a satisfactory functioning of the anatomical structures bordering the tumor. Materials and methods. This paper reports on 4 microsurgical excisions of acoustic neuroma while the patient is awake, carried out at the multidisciplinary hospital named after professor Makazhanov. The selection of patients was carried out by an interdisciplinary team of physicians, consisting of a neurosurgeon, a neurologist, a neuropsychologist, and a speech therapist. Results. The results of the research are controversial, two of the treated patients noticed a slight improvement in hearing, and the third patient lacked any dynamics, while the forth patient was dissatisfied due to hearing impairment. Conclusion. The functioning of the facial and other nerves of operated patients was not affected. [ABSTRACT FROM AUTHOR]

The auditory nerve tumor is the most common tumor of the cerebellopontine angle region (CPA). The use of modern diagnostic methods allows to detect the tumor at an early stage of development, and consequently, the possibility of effective treatment. The clinical features and the most effective diagnostic procedures are presented.

Objectives. In 1974, in the United States of America, ”Florida Ear and Sinus Center” initiated a ”Wait & Scan” approach for acoustic neurinoma. It consists of monitoring vestibular schwannoma patients, during several years, using magnetic resonance imaging. The aim of our study was to evaluate monitoring results of vestibular schwannoma patients. Material and Methods. In the Otorhinolaryngology clinic of the Republican Clinical Hospital „Timofei Moșneaga”, Chișinău, Republic of Moldova, were monitored 6 patients with vestibular schwannoma. In order to establish the diagnosis in these patients, the following diagnostic methods were used: audiometry, brainstem auditory evoked potential test, vestibulometry and magnetic resonance imaging exam. Results. In our study the following diagnoses were established: 1 case of intralabyrinthine vestibular schwannoma, 2 cases of intracanalicular vestibular schwannoma, 3 cases of 2nd grade vestibular schwannoma. Unilateral neurosensorial hypoacusis, in 5 cases, was the first symptom of this pathology. By American Academy of Otolaryngology - Head and Neck Surgery classification system, patients were distributed as follows: 4 cases of class D hypoacusis, 1 case of class C hypoacusis and, in 1 case, hearing was normal. According to the magnetic resonance imaging scan, two 2nd grade vestibular schwannoma patients showed tumor growth, while 2 cases of intracanalicular vestibular schwannoma were in stagnation. Conclusion. It is strongly necessary to perform contrast magnetic resonance imaging scan in patients with unilateral neurosensorial hypoacusis of unknown ethiology, in order to establish the diagnosis. Also, following the study, it was established that tumors that exceed the internal auditory canal, show a higher growth rate than intracanalicular tumors.

The article aims to consider the advantages and disadvantages of the “semi-sitting” position of patient during the surgery to remove vestibular schwannomas. We also decided to find out what methods of prevention exist in the world today and how effective are they? Based on a literature review, it was found that this situation is fundamentally different from the traditional position on the side, and one of the features that inhibit the wide application of the semi-sitting position is the risk of developing various complications. As a result of the analysis, it was found that with proper observance of conditions such as proper patient placement on the operating table, the use of all methods for early diagnosis of air embolism can minimize the risk of developing air embolism, paradoxical EI, tension pneumocephalus and other complications. This will help us to fully disclose all the advantages of the semi-sitting position and use it effectively. [ABSTRACT FROM AUTHOR]

Early diagnosis and treatment of vestibular schwannomas without complications to health is extremely important. It is necessary to identify the disease at the beginning of its development. Unfortunately, doctors main not give enough attention to a patient's complaints as hearing loss, do not widely use neuroimaging techniques. Therefore, patients go to the doctor in the later stages of the disease with severe neurological symptoms. This fact affects the outcome of treatment , so we need to find new ways of solving this problem. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the correlation of trigeminal radiculopathy with anatomical relationships of trigeminal nerve root, brainstem, tumors and vessels in patients with vestibular schwannomas., Material and Methods: A retrospective analysis included 153 patients (106 females and 47 males aged 22-82 years) with vestibular schwannomas who underwent surgery via retromastoid approach. Preoperative trigeminal radiculopathy (facial pain and sensory disturbances) was examined after microsurgical resection. Brainstem compression was analyzed by comparison of transverse size of contralateral to vestibular schwannoma half of brainstem and ipsilateral side., Results: Tumor-induced brainstem and trigeminal nerve compression was found in 115 cases. Sixty-four of these patients had trigeminal radiculopathy symptoms. Degree of brainstem compression was significantly higher in trigeminal radiculopathy group. Facial hypoesthesia was found in 61patients, trigeminal neuralgia - in 5 cases, neuropathic pain - in 3 patients. Thirty-seven patients without brainstem compression had no trigeminal nerve involvement. One patient had trigeminal neuralgia following compression by superior cerebellar artery. Total resection with brainstem and trigeminal nerve decompression were performed in all cases. Isolated or combined compression of trigeminal nerve root was noted in 9 patients with trigeminal neuralgia and neuropathic pain, in 2 with facial numbness and in 2 patients without trigeminal symptoms. In case of trigeminal neuralgia following compression by superior cerebellar artery, vascular decompression was performed only in patients with facial pain and numbness. Facial pain completely resolved in all patients. Complete or partial sensory restoration was noted in 25 cases. No facial sensory disorders were noted in 26 cases, transient sensory deterioration - in 10 patients., Conclusion: Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain. The impact of tumor on trigeminal nerve root and brainstem trigeminal pathways can be accompanied by vascular compression by superior cerebellar artery. Regression of trigeminal radiculopathy symptoms after resection of vestibular schwannoma is caused by decompression of trigeminal nerve root and brainstem. In case of concomitant neurovascular syndrome, vascular decompression is indicated.

The article presents a review of the literature on the vestibular schwannoma of childhood, the features of its clinical manifestations, diagnostic methods, methods of treating education and indications for their use.

Delayed facial palsy is a complication developing 3 or more days after surgery. The etiology and pathogenesis of this condition has not been fully explored, and there are no treatment standards for it. As in the case of Bell's paralysis, glucocorticosteroids (GCSs) are currently used to treat delayed facial palsy. However, patients with contraindications to GCSs need new therapy modalities., Aim: We aimed to evaluate the efficacy and safety of botulinum therapy in patients with delayed facial palsy after neurosurgical interventions., Material and Methods: We examined 33 patients with delayed facial palsy developed 3 or more days after resection of vestibular schwannoma. The main group included 18 patients with contraindications to GCSs who received injections of botulinum toxin A (BTA) into the facial muscles of the healthy side for muscle relaxation. The comparison group consisted of 15 patients who received a course of prednisolone (1 mg/kg/day) for 5-7 days. The efficacy of treatment was assessed using the House-Brackmann scale and Clinical Global Impression Scale. The follow-up period after therapy was 3 months., Results: Delayed facial palsy was more common in the following cases: the facial nerve was located near the antero-inferior tumor pole; the tumor was adherent to the facial nerve; the tumor extended in the oral direction; the tumor had with unclear borders and was 11 to 30 mm in size. In most patients of both groups, facial muscle palsy developed more than 11 days after surgery. Treatment both in the main and control groups resulted in a significant improvement: complete regression of the facial asymmetry in patients of the main group and comparison groups 3 months after treatment onset was 83.3 and 93.3% (House-Brackmann scale), respectively., Conclusion: Botulinum therapy may be recommended for patients with delayed facial palsy developed after vestibular schwannoma resection, who have contraindications to GCSs.

Introduction: Radiation therapy of small vestibular schwannomas is quite often used as an effective alternative to surgical treatment. At the same time, 2-10% of patients are detected with radioresistant tumors progressing to varying degrees, which is associated with continued tumor growth. In these cases, a decision on surgical resection or re-irradiation of the tumor is made depending on the neurological symptoms, patient's somatic status, and neuroimaging data. Surgical outcomes and intraoperative findings in pre-irradiated patients have been poorly represented in the literature, for which reason we decided to conduct this study. The paper presents a series of patients with vestibular schwannomas who underwent surgical removal of the tumor after radiotherapy., Material and Methods: A total of 39 patients with vestibular schwannomas after radiotherapy underwent surgery at the Burdenko Neurosurgical Institute in 2007-2017. Of these, 22 patients had a tumor removed after a previously performed combined surgical and radiotherapy treatment (group I), and 17 patients underwent tumor resection after previous radiological treatment (group II). The surgical outcomes were studied depending on various factors, and an analysis of the morphological changes in vestibular schwannomas after radiological treatment was carried out., Results: In group I, the tumor was resected totally in 18% of patients, almost totally in 5% of patients, subtotally in 68% of patients, and partially in 9% of patients. In group II, the tumor was resected totally in 6% of patients, almost totally in 12% of patients, subtotally in 76% of patients, and partially in 6% of patients. We found that post-radiation changes in patients undergoing surgery led to an increase in the response of neurovascular structures to surgical intervention, development of pronounced fibrosis around tumors, and changes in the structure of tumors that became more solid. As a result, surgical morbidity increased, and the patient's quality of life after surgery deteriorated.