Remote Ischemic Preconditioning in Vestibular Schwannoma Surgery

Vestibular schwannomas are primarily benign (WHO grade I) tumors originating from the Schwann cells of the vestibular nerve and are among the most common tumors of the skull base. Common treatment options are surgical tumor resection or targeted radiation therapy. The special challenge of surgical treatment is the functional preservation of the cranial nerves, especially the cochlear and facial nerves. Perioperative ischemia of the cochlea and cochlear nerve is postulated as the underlying mechanism of postoperative hearing loss. Ischemic preconditioning is a non-invasive procedure that triggers the release of vasoactive cytokines and mediators by repeated short-term induction of limb ischemia. Improved perfusion of critically perfused end organs as well as a reduction of cerebral infarct volumes has already been shown in other pathologies. In the planned study, possible neuroprotective effects of remote ischemic preconditioning on postoperative hearing as well as facial nerve function in patients with vestibular schwannomas will be examined.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* Age ≥ 18 years
* total or gross-total resection of a vestibular schwannoma is planned
* Functional hearing is still present on the affected side preoperatively (AEP evocable and Gardner-Robertson grade I, II, or III).
* Preoperatively, facial function is unimpaired or mildly impaired (House and Brackmann grade I or II).

Exclusion Criteria:

* Symptomatic peripheral artery disease.
* Active or previous thrombosis in the extremity where the RIC procedure is to be performed.
* Neurofibromatosis type 2
* Only planned decompression of the internal auditory canal without relevant tumor resection
* Pregnant or breastfeeding females
* Previous radiotherapy of the vestibular schwannoma that will be resected