Sporadic schwannomas and neurofibromas

Historical note and nomenclature
Article section 2 of 16.  Previous  Next

By Herbert B Newton MD

By most accounts, the earliest reported description of a vestibular schwannoma was by Sandifort, in 1777 (Sandifort 1777). The first clinicopathologic correlation was by Leveque-Lasource in 1810 (Leveque-Lasource 1810). The earliest complete clinical report of a patient with a vestibular schwannoma was by Bell in 1830, as described by Cushing (Cushing 1917). In 1835, Cruveilhier is credited with the most complete description of both the clinical and pathologic features of the tumor (Cruveilhier 1835). The first successful operative removal of a vestibular schwannoma was by Sir Charles Balance in 1894. Based on the clinical description and autopsy findings of a patient with a vestibular schwannoma that was localized and diagnosed antemortem, Von Monakow was of the opinion that patients with these tumors were excellent surgical candidates (Von Monakow 1900). This report generated much interest within the neurosurgical community in surgical therapy for vestibular schwannomas. Over the next 30 years, surgical techniques and approaches to intracranial schwannomas were refined to such a degree that operative mortality was reduced from approximately 50% to 60% in the early 1900s to 4% by 1931 (Macfarlane and King 1995). New techniques introduced by Cushing (eg, subtotal tumor removal, decompressive suboccipital craniectomy, uncapping of the cerebellum) were responsible for much of this improvement. Further refinement in surgical techniques, the use of intraoperative monitoring, and the advent of CT and MRI have further improved surgical morbidity and mortality over the last 30 years.