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Alireza Gharabaghi, Andrei Koerbel, Amir Samii, Jan Kaminsky, Henning Von Goesseln, Marcos Tatagiba and Madjid Samii

auditory function and internal auditory canal pressure in patients with vestibular schwannomas . J Neurosurg 96 : 872 – 876 , 2002 25 Locke MM , Spiekermann BF , Rich GF : Trigeminovagal reflex during repair of a nasal fracture under general anesthesia . Anesth Analg 88 : 1183 – 1184 , 1999 26 Loewinger J , Cohen M , Levi E : Bradycardia during elevation of a zygomatic arch fracture . J Oral Maxillofac Surg 45 : 710 – 711 , 1987 27 Matthies C , Samii M : Management of 1000 vestibular schwannomas (acoustic neuromas): clinical

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Andrei Koerbel, Alireza Gharabaghi, Sam Safavi-Abbasi, Marcos Tatagiba and Madjid Samii

The extraordinary improvement of patient outcome after surgical treatment for vestibular schwannomas is relatively recent and has occurred mainly over the last 30 years. The introduction of microsurgical techniques has resulted in increasing degrees of precise anatomical and functional preservation of the facial and cochlear nerves. An expanded microsurgical technique accompanied by continuous electrophysiological monitoring has resulted in marked changes in the primary goals for this surgery. Whereas in the past the primary goal of vestibular schwannoma management was to preserve the patient's life, the objective in vestibular schwannoma treatment today is to preserve neurological function.

Long-term follow-up examinations show negligible recurrence rates, indicating that the aim of preservation of nerve function does not limit the completeness of tumor removal with modern neurosurgical techniques. Despite these advances in preserving the anatomical integrity of, for example, the cochlear nerve, losses of function and even deafness may occur postoperatively in some cases. Current biological and technical research in experimental and clinical settings addresses these problems. In this article, the authors report in detail the developments achieved in vestibular schwannoma surgery and the great clinicians to whom these results can be credited.

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Bernhard J. Schaller

size has only indirect influence, however; the main determinant of the occurrence of the TCR is the localization of the lesion that is operated on. This fact is underscored by our studies in other types of skull base surgery 3 , 4 in which there are different incidence rates of TCR as those found by Schaller and coworkers 5 or Gharabaghi et al. References 1 Gardner G , Robertson JH : Hearing preservation in unilateral acoustic neuroma surgery . Ann Otol Rhinol Laryngol 97 : 55 – 66 , 1988 2 Gharabaghi A , Acioly de Sousa A , Tatagiba M

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Neurosurgical Forum: Letters to the Editor To The Editor Marcos Tatagiba , M.D., Ph.D. Steffen Rosahl , M.D. Ulrike Blömer , M.D., Ph.D. Alireza Gharabaghi Martin Böhme Madjid Samii , M.D. Ph.D. Medizinische Hochschule, Hannover, Germany 147 149 Abstract Object. Cochlear neurons are inevitably exposed to traumatic stress during surgical removal of an acoustic neuroma; that event is an important cause of postoperative cochlear neuronal

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Lennart H. Stieglitz, Karsten H. Wrede, Alireza Gharabaghi, Venelin M. Gerganov, Amir Samii, Madjid Samii and Wolf O. Luedemann

fluid leak after microsurgical removal of vestibular schwannomas . Acta Neurochir (Wien) 144 : 979 – 982 , 2002 3 Becker SS , Jackler RK , Pitts LH : Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches . Otol Neurotol 24 : 107 – 112 , 2003 4 Bernal-Sprekelsen M , Alobid I , Mullol J , Trobat F , Tomas-Barberan M : Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis . Rhinology 43 : 277 – 281 , 2005 5 Brennan JW

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Christian Scheller, Stefan Rampp, Marcos Tatagiba, Alireza Gharabaghi, Kristofer F. Ramina, Oliver Ganslandt, Barbara Bischoff, Cordula Matthies, Thomas Westermaier, Maria Teresa Pedro, Veit Rohde, Kajetan von Eckardstein and Christian Strauss

Wilhelm-Roux Program (grant nos. FKZ 19/07 and FKZ 23/26) of the Medical Faculty of the University of Halle-Wittenberg, Germany; and the Acoustic Neuroma brain tumour (AN) and Interest Group (IGAN), Switzerland. We thank Monika Göttlich, Jenny Hampel, Melanie Querfurt, Cornelia Seiffert, Christin Zöller, and study nurses for administrative contributions and assistance in performing this study. Disclosures Funding was received from Bayer Health Care, Germany. Author Contributions Conception and design: Scheller. Acquisition of data: Scheller, Tatagiba, Gharabaghi, Ramina

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Madjid Samii, Andrei Koerbel, Sam Safavi-Abbasi, Federico Di Rocco, Amir Samii and Alireza Gharabaghi

– 185 , 2003 12 Samii M : Facial nerve grafting in acoustic neurinoma . Clin Plast Surg 11 : 221 – 225 , 1984 13 Samii M : [The indications, technique and results of facio-facial anastomosis.] . Neurochirurgia (Stuttg) 24 : 90 – 93 , 1981 . (Ger) 14 Samii M , Matthies C : Indication, technique and results of facial nerve reconstruction . Acta Neurochir (Wien) 130 : 125 – 139 , 1994 15 Samii M , Matthies C : Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections . Neurosurgery

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Christian Scheller, Andreas Wienke, Marcos Tatagiba, Alireza Gharabaghi, Kristofer F. Ramina, Oliver Ganslandt, Barbara Bischoff, Johannes Zenk, Tobias Engelhorn, Cordula Matthies, Thomas Westermaier, Gregor Antoniadis, Maria Teresa Pedro, Veit Rohde, Kajetan von Eckardstein, Thomas Kretschmer, Malte Kornhuber, Jörg Steighardt, Michael Richter, Fred G. Barker II and Christian Strauss

, Robertson JH : Hearing preservation in unilateral acoustic neuroma surgery . Ann Otol Rhinol Laryngol 97 : 55 – 66 , 1988 5 Gharabaghi A , Koerbel A , Samii A , Kaminsky J , von Goesseln H , Tatagiba M , : The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery . J Neurosurg 104 : 369 – 375 , 2006 6 Guntinas-Lichius O , Martinez-Portillo F , Lebek J , Angelov DN , Stennert E , Neiss WF : Nimodipine maintains in vivo the increase in GFAP and enhances the

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Christian Scheller, Andreas Wienke, Marcos Tatagiba, Alireza Gharabaghi, Kristofer F. Ramina, Oliver Ganslandt, Barbara Bischoff, Cordula Matthies, Thomas Westermaier, Gregor Antoniadis, Maria Teresa Pedro, Veit Rohde, Kajetan von Eckardstein, Thomas Kretschmer, Johannes Zenk and Christian Strauss

JS Jr , Kwartler JA : Predicting long-term facial nerve outcome after acoustic neuroma surgery . Otolaryngol Head Neck Surg 108 : 220 – 224 , 1993 2 Carlson ML , Jacob JT , Pollock BE , Neff BA , Tombers NM , Driscoll CL , : Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline . J Neurosurg 118 : 579 – 587 , 2013 3 Chee GH , Nedzelski JM , Rowed D : Acoustic neuroma surgery: the results of long-term hearing

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Christian Scheller, Andreas Wienke, Marcos Tatagiba, Alireza Gharabaghi, Kristofer F. Ramina, Oliver Ganslandt, Barbara Bischoff, Johannes Zenk, Tobias Engelhorn, Cordula Matthies, Thomas Westermaier, Gregor Antoniadis, Maria Teresa Pedro, Veit Rohde, Kajetan von Eckardstein, Thomas Kretschmer, Malte Kornhuber, Jörg Steighardt, Michael Richter, Fred G. Barker II and Christian Strauss

for the Evaluation of Hearing Preservation in Acoustic Neuroma (vestibular schwannoma)” of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). 16 Tumor size (according to the Koos grading system) and extent of resection were evaluated by the investigators for the pilot study and in a blinded fashion by a neuroradiologist on the basis of axial contrast-enhanced T1-weighted MRI studies performed preoperatively and 3 months after surgery for the multicenter trial. 11 Side effects, concomitant medication, and comorbidity were documented descriptively