Speakers

Functional Preservation in Vestibular Schwannoma
1110 10:10-10:20
AASNS / AANS Joint Session "Spetzler Symposium"/305
Based on the author’s experience in the interventions of nearly 2500 cerebellopontine angle tumours and 1500 VSs, the essential steps of Retrosigmoid approach for optimal outcome will be demonstrated on video with case examples. Vestibular Schwannoma is a common benign brain tumour. Appropriately and managed at the right time, the patient remains fully functional and can be cured. It is also important to remember that all patients with VS do not require intervention and there are different ways of managing a given patient with VS, observation & surveillance, radiosurgery and microsurgery. While different microsurgical approaches are recommended for different size and presentation of VS, the retrosigmoid approach is appropriate for all types of VS where microsurgery is indicated. It is better to master one technique, and the authors would recommend RSSOC for microsurgery of VS. Over a period, the thrust has changed from an attempt of total excision at any cost to preservation of function. VS being a benign tumor, a small sliver of tumor left attached to the facial nerve to have a better facial function is better and more acceptable to the patient. This has resulted in significant improvement of facial function. Often this small residue doesn’t grow nor need any further treatment. In the event of its growth, it can be safely reoperated or treated by radiosurgery. Finally, microsurgery is not medicine and quoting the literature for the results has no relevance. Every neurosurgeon should find the paradigm that is best in her/his hands. Auditing one’s own results and the outcome of the last 100 cases managed by the neurosurgeon should be the basis of her/his recommendation for the 101st patient! Preservation of facial function following microsurgery in all sizes of tumour and hearing preservation in Koos 1 & 2 tumours should be goal of treatment.

Microsurgery of Complex Cerebral Aneurysms
1109 08:50-09:00
AASNS & WANS Joint Seminar/305
Advances in endovascular therapy (EVT) have made EVT an attractive option in the treatment of cerebral aneurysms. Hence, microsurgery is more often employed for complex aneurysms. There are numerous factors other than size that make a given intracranial aneurysm “complex.” These factors include: • Location: difficult access • Configuration: complicated wall structure, blister aneurysms, involving arterial trunks and branches, pseudoaneurysms, intraluminal thrombus, wall calcification, presence of intraluminal thrombus, mural or parent vessels calcification • Size: very large and giant aneurysms • Failed surgical or failed endovascular treatment (acute, recent or past) Their management is problematic because of the wide atheromatous neck, involved branches, thrombus within, calcified wall, large size, complex anatomy and previous failed treatment. Yet, these need treatment because of their disastrous natural history. Any decision to intervene should carefully consider the various options like microsurgery, EVT and observation. The treatment should be patient centric taking all the patient factors, pathological factors and expertise available and any intervention should be expected to better the natural history. There have been many advances in recent years in microsurgery. Skull base approaches, neuro protection measures, adjuncts like adenosine induced cardiac standstill, rapid ventricular pacing, extracorporeal circulation, intraoperative ICG angiography, innovative use of clips and various bypass techniques have made it possible to achieve satisfactory results in majority of complex aneurysms bettering the natural history and other options. However, their treatment is a major endeavor and should not be taken up by the occasional aneurysm surgeon. Experienced groups in specialized centers with all available resources are best suited to tackle these life-threatening pathologies. Video demonstration of microsurgery of complex aneurysms will be done.

1. Eloquent Region Cavernoma 2. Microsurgery of complex aneurysms 3. Microsurgery of vestibular schwannoma following failed radiosurgery
1109 13:55-14:05
Video Presentation/304B

PANEL DISCUSSION 3: Challenging Cerebrovascular Cases
1110 16:05-16:45
AASNS / AANS Joint Session "Spetzler Symposium"/305