History of vestibular schwannoma management.

Eduard Sandifort, was the first to describe a vestibular schwannoma (VS) (acoustic neuroma) at postmortem in 1777. Pirsig, in 1991, described the temporal bone findings in the skeletons of two children buried in an early bronze age cemetery at Franzenhausen in Austria dating back to 2500 BC which are consistent with the bilateral VS of NF2-related schwannomatosis. The first attempts at VS surgery began in the late 19th century with the first successful removal by Annandale in Edinburgh in 1895. Early operative mortality rates were as high as 86%. The suboccipital approach was first popularized in 1903 by Krause, the same year that the translabyrinthine approach was originally proposed by Panse. Helped by the new microsurgical technology, House initially developed the middle fossa approach to the internal meatus, through which hearing preservation possibilities in NF2 were proposed. NF2 itself was first reported by Wishart in 1822 although due to conflation with NF1 by Cushing in the early twentieth century it took another 70 years to fully separate NF2 from NF1 and only recently has NF2 lost its 'neurofibromatosis' to be renamed NF2-related schwannomatosis. Surgical results for sporadic and NF2-related VS are now hugely improved with very low mortality rates, but the huge increase in diagnosis of indolent sporadic VS in recent years means many diagnosed with VS will never require treatment.