Vestibular schwannoma is a benign tumor growing from the balance nerve, most often causing hearing and balance disorders. If the tumor is small and not growing, the patient can only be monitored. In the case of growth, it gradually begins to oppress the brainstem, which can lead to life-threatening complications, and it is necessary to proceed actively. Approximately 200-300 new patients with this type of tumor are diagnosed annually in our country. Clinic otorhinolaryngology and head and neck surgery 1st Faculty of Medicine UK and FN Motol in the last 25 years, it has introduced a whole range of innovative procedures and technologies in the Czech Republic, which have improved the quality of care for these patients.
In 1997, the head of the clinic, prof. MD Jan Betka, PhD. together with neurosurgeon prof. MD Eduard Zvěřina, DrSc. agreed on cooperation in the field of cranial base diseases and especially vestibular schwannomas. A year later, the first four patients were operated on at the clinic. All cases used a retrosigmoid approach (a method that allows doctors to access the back of the brain through a small opening behind the ear). This interdisciplinary cooperation was unique at the time and today it is still the only workplace in the Czech Republic that uses the experience of both specialties. Over time, the team was expanded to include other necessary medical professions – neurology, neurophysiology, physiotherapy, anesthesiology, ophthalmology, oncology, plastic surgery and others. All these professions are specifically dealing with the given issue within the framework of Motol. Currently, the work of the founders continues as MD Zdeněk Fík, Ph.D. (Clinic of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine UK and FN Motol) and as. MD Aleš Vlasák, Ph.D. (Neurosurgery Clinic for Children and Adults 2. Faculty of Medicine UK and FN Motol).
Implementation of innovative procedures and technologies
With the aim of achieving complete removal of the tumor from the area of the hard-to-reach internal auditory canal, work with the operating microscope was supplemented by the use of endoscope.
"This endoscopically assisted surgery allows radical removal of the tumor to be achieved in more than 95% of cases while preserving the safety of the facial and sometimes the auditory nerve," explains as MD Zdeněk Fík, Ph.D.
Since 2021, it has become an integral part of vestibular schwannoma operatives due to its image quality and convenient handling Exoscope (special form of 3D microscope). It ensures safer and more precise work in the area of the internal ear canal, formed by bone piezoelectric knife. It was also included in the portfolio of intraoperative neuromonitoring techniques direct auditory nerve monitoring (CNAP).
"Preserving the facial nerve during vestibular schwannoma surgery is now almost a matter of course, but preserving hearing is still a problematic issue. The CNAP method allows us to provide almost real-time information about the functionality of the nerve and adapt the surgery tactics to it." says Dr. Fík, adding at the same time:
"Today, we can offer patients who, for various reasons, still lose their hearing hearing aid integrated into the bone (BAHD bone anchored hearing device), which makes it possible to pick up sounds from the deaf side with the other, hearing ear. Where the auditory nerve can be preserved, we further consider cochlear implantation."
Program milestones
1999 – For the first time in the Czech Republic, a stem implant was implanted in a patient with complete deafness due to multiple schwannomas and other tumors within the framework of the disease Neurofibromatosis type 2.
2001 – The translabyrinthine approach (a surgical technique allowing doctors to access the inner ear and adjacent structures through a small opening in the labyrinth) was included in the portfolio of surgical approaches. This still accounts for approximately 5% of all approaches used.
2005 – The first anastomosis was performed between the buccal and sublingual nerves to improve the function of the paralyzed face. The clinic has the largest set of such patients to date.
2015 – The Department of Otorhinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine of the UK and the Motol General Hospital, in cooperation with the Oncology Clinic of the 2nd Faculty of Medicine of the UK and the Motol General Hospital, has started biological treatment for patients with an advanced and complicated course of the disease
Neurofibromatosis type 2.
2019 – Professor Betka, in cooperation with Professor David Netuka, founded the Cooperative Group for Diseases of the Cranial Base, uniting the workplaces of the 1st Faculty of Medicine, UK, dealing with patients with diseases of the skull base.
2022 – An interdisciplinary working group for patients with facial nerve disease and scientific research on vestibular schwannomas operates at Motol Medical Center with the aim of understanding the nature of this disease.
During the 25 years of operation of the program, more than 1400 patients were consulted at the clinic. Approximately half of the patients were and are still included in the monitored branch without the need for intervention. 680 patients were operated on, the youngest was 12 years old, the oldest was 81 years old. The number of patients operated on for vestibular schwannoma at the Department of Otorhinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine, UK, has been consistently above 10 per year for the past 30 years. In 2023, 40 patients were operated on.
"More than half of the tumors are large tumors, mostly compressing the brainstem and cerebellum. The basic philosophy of our workplace is to achieve radical removal of the tumor with the aim of sparing all affected nerve structures, which in most cases succeeds,” concludes Dr. Fig.
You can learn more about the treatment of vestibular schwannoma on the website Clinics of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine UK and FN Motol.
Press Release: History and future_vestibular schwannoma