Title: The learning curve in vestibular schwannoma surgery.

Authors: Welling DB, Slater PW, Thomas RD, McGregor JM, Goodman JE
Location: Department of Otolaryngology, The Ohio State University, Columbus 43210, USA.

Source: Am J Otol 1999 Sep;20(5):644-8


OBJECTIVE: This study aimed to examine the effect of surgical team experience on facial nerve function and complication rate in vestibular schwannoma surgery.

STUDY DESIGN: The study design was a retrospective analysis of a case series.

SETTING: The study was conducted at a tertiary referral center.

PATIENTS: One hundred sixty consecutive patients undergoing vestibular schwannoma excision participated.

INTERVENTION: Surgical excision of vestibular schwannoma via atranslabyrinthine, middle cranial fossa, suboccipital, or combined approach was performed.

MAIN OUTCOME MEASURES:Facial nerve function (House-Brackmann score) and complication rates including cerebrospinal fluid leak and meningitis compared by groups of 20 patients were measured.

RESULTS: There was a statistically significant improvement in the numberof patients achieving a House-Brackmann grade I result between the first 20 patients (35% House-Brackmann grade 1) andthe ensuing 7 groups of 20 patients (74% House-Brackmann grade 1) by chi2 analysis. When considering House grades I and II together, there was no statistically significant difference in facial nerve function in the first 20 patients (80%) compared to thelast 7 groups of 20 patients (88%) by Tukey's pairwise comparisons (p = 0.245). Mean tumor size was not significantly different in the groups studied (p = 0.54). The total cost of patient care declined over the study period; however, the widecase-to-case variance made it so that this trend was not statistically significant (p = 0.448).

CONCLUSIONS: A learning curve of 20 patients was demonstrated by this study to have been necessary for attaining acceptable standards in the surgical removal of vestibular schwannomas by a new surgical team. The findings of this study may have implications for patient care and surgeon training.

Inez's note: At the 1999 ANA Symposium, I think I remember hearing the number 40 or so; but no amount of surgical experience would lead me to chose surgery.

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