Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2022

Open Access 01-12-2022 | Vestibular Schwannoma | Study protocol

The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial

Authors: Xiaolong Wu, Xu Wang, Gang Song, Mingchu Li, Chengbei Hou, Ge Chen, Hongchuan Guo, Xinru Xiao, Jie Tang, Qingtang Lin, Yuhai Bao, Jiantao Liang

Published in: Trials | Issue 1/2022

Login to get access

Abstract

Background

There is an ongoing discussion about the advantages and disadvantages of different surgical positions (semi-sitting and lateral position) for vestibular schwannoma surgery. Each position has its advantages, disadvantages, challenges, and risk profiles. The objectives of this study are to compare the effects of different surgical positions (semi-sitting and lateral position) on the outcomes of large vestibular schwannoma, primarily including effectiveness and safety.

Methods

In this single-centre, open, randomized controlled trial, we will recruit a total of 116 participants according to the inclusion and exclusion criteria who will be randomized to an experimental group or control group. Patients will undergo operations in semi-sitting and lateral positions. The primary endpoint will be the percentage of gross total resection. The secondary endpoints will include the facial nerve function, hearing preservation, surgical position placement time, time of operation (skin-to-skin surgical time), hospital stay, total hospitalization fee, and complications. The follow-up period will be at least 12 months, during which time patients will be evaluated both clinically and radiologically.

Discussion

This issue is still debated after 30 years since the first large comparative study was published in 1989, so the study will be useful. Therefore, more high-quality studies are required to compare clinical outcomes, complications, and other factors associated with these two positions.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900027550​. Registered on 17 November 2019
Literature
1.
Jung S, Kang SS, Kim TS, Kim HJ, Jeong SK, Kim SC, et al. Current surgical results of retrosigmoid approach in extralarge vestibular schwannomas. Surg Neurol. 2000;53(4):370–7 discussion 7-8.CrossRef
2.
Espahbodi M, Carlson ML, Fang TY, Thompson RC, Haynes DS. Small vestibular schwannomas presenting with facial nerve palsy. Otol Neurotol. 2014;35(5):895–8.CrossRef
3.
Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery. 1997;40(1):11–21 discussion -3.PubMed
4.
Rahne T, Plossl S, Plontke SK, Strauss C. Preoperative determination of nerve of origin in patients with vestibular schwannoma. HNO. 2017;66(Suppl 1):16–21.
5.
Breun M, Nickl R, Perez J, Hagen R, Lohr M, Vince G, et al. Vestibular schwannoma resection in a consecutive series of 502 cases via the retrosigmoid approach: technical aspects, complications, and functional outcome. World Neurosurg. 2019;129:e114–e27.CrossRef
6.
Martin TP, Senthil L, Chavda SV, Walsh R, Irving RM. A protocol for the conservative management of vestibular schwannomas. Otol Neurotol. 2009;30(3):381–5.CrossRef
7.
Sughrue ME, Kane AJ, Kaur R, Barry JJ, Rutkowski MJ, Pitts LH, et al. A prospective study of hearing preservation in untreated vestibular schwannomas. J Neurosurg. 2011;114(2):381–5.CrossRef
8.
Rowe JG, Radatz MW, Walton L, Hampshire A, Seaman S, Kemeny AA. Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas. J Neurol Neurosurg Psychiatry. 2003;74(11):1536–42.CrossRef
9.
Matsuo T, Okunaga T, Kamada K, Izumo T, Hayashi N, Nagata I. Long-term follow-up results of linear accelerator-based radiosurgery for vestibular schwannoma using serial three-dimensional spoiled gradient-echo MRI. J Clin Neurosci. 2015;22(2):320–5.CrossRef
10.
Koos WT, Spetzler RF, Bock FW, Salah S. Microsurgery of cerebellopontine angle tumors. In: Clinical microneurosurgery. Stuttgart: Georg Thieme; 1976. p. 91–112.
11.
Talfer S, Dutertre G, Conessa C, Desgeorges M, Poncet JL. Surgical treatment of large vestibular schwannomas (stages III and IV). Eur Ann Otorhinolaryngol Head Neck Dis. 2010;127(2):63–9.CrossRef
12.
Sepehrnia A, Borghei-Razavi H. Vestibular schwannoma between 1 and 3 cm: importance of the tumor size in surgical and functional outcome. Clin Neurol Neurosurg. 2015;129:21–6.CrossRef
13.
Acioly MA, Liebsch M, de Aguiar PH, Tatagiba M. Facial nerve monitoring during cerebellopontine angle and skull base tumor surgery: a systematic review from description to current success on function prediction. World Neurosurg. 2013;80(6):e271–300.CrossRef
14.
Scheller C, Rampp S, Tatagiba M, Gharabaghi A, Ramina KF, Ganslandt O, et al. A critical comparison between the semisitting and the supine positioning in vestibular schwannoma surgery: subgroup analysis of a randomized, multicenter trial. J Neurosurg. 2019:1–8. Online ahead of print
15.
Roessler K, Krawagna M, Bischoff B, Rampp S, Ganslandt O, Iro H, et al. Improved postoperative facial nerve and hearing function in retrosigmoid vestibular schwannoma surgery significantly associated with semisitting position. World Neurosurg. 2016;87:290–7.CrossRef
16.
Black S, Ockert DB, Oliver WC Jr, Cucchiara RF. Outcome following posterior fossa craniectomy in patients in the sitting or horizontal positions. Anesthesiology. 1988;69:49–56.CrossRef
17.
Rath GP, Bithal PK, Chaturvedi A, Dash HH. Complications related to positioning in posterior fossa craniectomy. J Clin Neurosci. 2007;14(6):520–5.CrossRef
18.
Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg. 2006;105(4):527–35.CrossRef
19.
Feigl GC, Decker K, Wurms M, Krischek B, Ritz R, Unertl K, et al. Neurosurgical procedures in the semisitting position: evaluation of the risk of paradoxical venous air embolism in patients with a patent foramen ovale. World Neurosurg. 2014;81(1):159–64.CrossRef
20.
Standefer M, Bay JW, Trusso R. The sitting position in neurosurgery: a retrospective analysis of 488 cases. Neurosurgery. 1984;14(6):649–58.CrossRef
21.
Safdarian M, Safdarian M, Chou R, Hashemi SMR, Rahimi-Movaghar V. A systematic review about the position-related complications of acoustic neuroma surgery via suboccipital retrosigmoid approach: sitting versus lateral. Asian J Neurosurg. 2017;12(3):365–73.CrossRef
22.
Himes BT, Mallory GW, Abcejo AS, Pasternak J, Atkinson JLD, Meyer FB, et al. Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. J Neurosurg. 2017;127(1):182–8.CrossRef
23.
Jadik S, Wissing H, Friedrich K, Beck J, Seifert V, Raabe A. A standardized protocol for the prevention of clinically relevant venous air embolism during neurosurgical interventions in the semisitting position. Neurosurgery. 2009;64(3):533–8 discussion 8-9.CrossRef
24.
Jurgens S, Basu S. The sitting position in anaesthesia: old and new. Eur J Anaesthesiol. 2014;31:285–91.CrossRef
25.
Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg. 2010;112(4):860–7.CrossRef
26.
Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ (Clinical research ed). 2013;346:e7586.
27.
Hurwitz EE, Simon M, Vinta SR, Zehm CF, Shabot SM, Minhajuddin A, et al. Adding examples to the ASA-Physical Status Classification improves correct assignment to patients. Anesthesiology. 2017;126(4):614–22.CrossRef
28.
Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74(3):373–9.CrossRef
29.
House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93:146–7.CrossRef
30.
Committee on Hearing and Equilibrium(Members of the Committee on Hearing and Equilibrium: Edwin M. Monse U, MD, PhD, Chairman; Thomas A. Balkany, MD; George A. Gates, MD; Robert A. Goldenberg, MD; William L. Meyerhoff, MD, PhD; and John W. House, MD, Consultant) Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg. 1995;113(3):179–80.
31.
Spektor S, Fraifeld S, Margolin E, Saseedharan S, Eimerl D, Umansky F. Comparison of outcomes following complex posterior fossa surgery performed in the sitting versus lateral position. J Clin Neurosci. 2015;22(4):705–12.CrossRef
Metadata
Title
The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial
Authors
Xiaolong Wu
Xu Wang
Gang Song
Mingchu Li
Chengbei Hou
Ge Chen
Hongchuan Guo
Xinru Xiao
Jie Tang
Qingtang Lin
Yuhai Bao
Jiantao Liang
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Trials / Issue 1/2022
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-022-06437-z

Other articles of this Issue 1/2022

Trials 1/2022 Go to the issue

Study protocol

Rehabilitation for children with chronic acquired brain injury in the Child in Context Intervention (CICI) study: study protocol for a randomized controlled trial

Study protocol

A laparoscopic one anastomosis gastric bypass with wrapping versus nonwrapping fundus of the excluded part of the stomach to treat obese patients (FundoRingOAGB trial): study protocol for a randomized controlled trial

Study protocol

Evaluation of the PhunkyFoods intervention on food literacy and cooking skills of children aged 7–9 years: a cluster randomised controlled trial in Yorkshire Primary Schools UK

Study protocol

Effect of antisecretory factor, given as a food supplement to adult patients with severe traumatic brain injury (SASAT): protocol for an exploratory randomized double blind placebo-controlled trial

Study protocol

Peer specialists deliver cognitive behavioral social skills training compared to social skills training and treatment as usual to veterans with serious mental illness: study protocol for a randomized controlled trial

Study protocol

Cluster randomised control trial protocol for estimating the effectiveness and cost-effectiveness of a complex intervention to increase care home staff influenza vaccination rates compared to usual practice (FLUCARE)