Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Ren, Yin; MacDonald, Bridget V; Tawfik, Kareem O.; Schwartz, Marc S.; Friedman, Rick A.

doi:10.1177/0194599820961389

Cited by 23 publications

(28 citation statements)

References 80 publications

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“…The difference in statistical conclusions is caused by the inconsistency of inclusion criteria. The grade of resection is also controversial, with some studies showing no association of grade of resection with FN outcomes ( 29 ) and with other studies showing an association with poor FN outcomes ( 30 ). There was no correlation between extent of resection and prognosis of FN in our separate analysis ( Z = 1.139, p = 0.187, Supplementary Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Another reason is that each surgeon has a different strategy for tumor removal. The surgeon is commonly faced with balancing aggressive dissection to separate the nerve, which may result in injury, with less aggressive resection, which may risk tumor growth ( 30 ). For the tumor with strong adhesion, each surgeon chooses different, if the pursuit of total resection will increase the probability of FN injury.…”

Section: Discussionmentioning

confidence: 99%

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Nomogram for Predicting Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Sun

Yang

et al. 2022

Front. Neurol.

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ObjectiveThe facial nerve (FN) outcomes after vestibular schwannoma surgery seriously affect the social psychology and quality of life of patients. More and more attention has been paid to the protection of FN function. This study aimed to identify significant prognostic factors for FN outcomes after vestibular schwannoma surgery and create a new nomogram for predicting the rates of poor FN outcomes.MethodsData from patients who had undergone operations for vestibular schwannoma between 2015 and 2020 were retrieved retrospectively and patients were divided into good and poor FN outcomes groups according to postoperative nerve function. The nomogram for predicting the risk of poor FN outcomes was constructed from the results of the univariate logistic regression analysis and the multivariate logistic regression analysis of the influencing factors for FN outcomes after surgical resection of vestibular schwannoma.ResultsA total of 392 participants were enrolled. The univariate logistic regression analysis revealed that age, tumor size, cystic features of tumors, cerebrospinal fluid (CSF) cleft sign, tumor adhesion to the nerve, learning curve, and FN position were statistically significant. The multivariate logistic regression analysis showed that age, tumor size, cystic features of tumors, CSF cleft sign, tumor adhesion to the nerve, learning curve, and FN position were independent factors. The nomogram model was constructed according to these indicators. At the last follow-up examination, a good FN outcome was observed in 342 patients (87.2%) and only 50 patients (12.8%) was presented with poor FN function. Application of the nomogram in the validation cohort still gave good discrimination [area under the curve (AUC), 0.806 (95% CI, 0.752–0.861)] and good calibration.ConclusionThis study has presented a reliable and valuable nomogram that can accurately predict the occurrence of poor FN outcomes after surgery in patients. This tool is easy to use and could assist doctors in establishing clinical decision-making for individual patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nomogram for Predicting Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Sun

Yang

et al. 2022

Front. Neurol.

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“…Although not directly evaluated in the current study as TL cases were excluded, a prior consensus statement notes the lack of high‐level evidence unequivocally supporting one approach over another 28 . Notably, despite occasional opinions to the contrary, facial nerve outcomes have been noted to be largely equitable between the RS and TL approaches in most studies and systematic reviews when accounting for tumor size 28–31 . Even the frequently referenced benefit of lower postcraniotomy headache rates after a TL approach appears limited, with multicenter cross‐sectional studies noting no statistically significant difference in the likelihood of long‐term severe headache among approaches using a disease‐specific quality of life measure 17,18 or when using the headache disability inventory 19 .…”

Section: Discussionmentioning

confidence: 89%

“…28 Notably, despite occasional opinions to the contrary, facial nerve outcomes have been noted to be largely equitable between the RS and TL approaches in most studies and systematic reviews when accounting for tumor size. [28][29][30][31] Even the frequently referenced benefit of lower postcraniotomy headache rates after a TL approach appears limited, with multicenter cross-sectional studies noting no statistically significant difference in the likelihood of long-term severe headache among approaches using a disease-specific quality of life measure 17,18 or when using the headache disability inventory. 19 Specifically, Carlson et al noted severe headaches were observed in 31% of patients undergoing a RS approach versus 32% of patients undergoing a TL approach at the time of survey.…”

Section: Discussionmentioning

confidence: 99%

Hearing Preservation Microsurgery in Vestibular Schwannomas: Worth Attempting in “Larger” Tumors?

et al. 2021

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Objectives/Hypothesis: To review hearing preservation after microsurgical resection of sporadic vestibular schwannomas according to tumor size.Study Design: Retrospective cohort. Methods: Baseline, intraoperative, and postoperative patient and tumor characteristics were retrospectively collected for a cohort who underwent hearing preservation microsurgery. Serviceable hearing was defined by a pure tone average ≤50 dB and word recognition score ≥50%.Results: A total of 243 patients had serviceable hearing preoperatively. Fifty (21%) tumors were confined to the internal auditory canal, and the median tumor size was 16.2 mm (interquartile range [IQR] 11.3-23.2) for tumors with cerebellopontine angle extension. Serviceable hearing was maintained in 64% of patients with tumors confined to the internal auditory canal, 28% with cerebellopontine angle extension <15 mm, and 9% with cerebellopontine angle extension ≥15 mm. On multivariable analysis, the odds ratios of acquiring nonserviceable hearing postoperatively for tumors extending <15 mm and ≥15 mm into the cerebellopontine angle were 5.75 (95% confidence interval [CI] 2.13-15.53; P < .001) and 22.11 (95% CI 7.04-69.42; P < .001), respectively, compared with intracanalicular tumors.Conclusions: The strongest predictor of hearing preservation with microsurgery after multivariable adjustment is tumor size. Approximately 10% of patients with tumors ≥15 mm of cerebellopontine angle extension will retain serviceable hearing after microsurgery. Furthermore, hearing preservation techniques offer cochlear nerve preservation and cochlear patency allowing for possible future cochlear implantation. An attempt at hearing preservation, including avoiding surgical approaches that necessarily sacrifice hearing, is worthwhile even in larger tumors if serviceable hearing is present preoperatively.

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“…The motivation to achieve good facial nerve function with microsurgery has been further pushed by the generally excellent outcomes reported for conventional low-dose stereotactic radiosurgery and active surveillance. Numerous past publications have identified potential contributing factors to facial nerve dysfunction in the postoperative setting, showcasing its importance within the literature (3)(4)(5)(6)(7)(8)(9). However, despite this focus on the outcome itself, few large studies have described the natural course of this dysfunction and potential predictors of recovery after it has occurred.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Age on Facial Nerve Recovery After Vestibular Schwannoma Resection

Macielak¹,

Lohse

Wallerius³

et al. 2023

Otol Neurotol

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Objective The objective of this study is to assess the influence of age on facial nerve recovery after microsurgical resection of sporadic vestibular schwannoma. Study Design A historical cohort study was performed. Setting The study was performed at a tertiary referral center. Patients The studied cohort included patients with a House–Brackmann (HB) Grade III or worse in the immediate postoperative period. Interventions The studied intervention was microsurgical resection. Main Outcome Measures The main outcome measure was complete recovery of facial nerve function to HB Grade I at least 12 months postoperatively. Results There were six patients with intracanalicular tumors and 100 with cerebellopontine angle (CPA) tumors eligible for study. Given the few patients with intracanalicular tumors, no further analysis was pursued in this subset. For patients with CPA tumors, a multivariable analysis of several patient and tumor characteristics demonstrated age at surgery (odds ratio for 10-year increase of 0.68; 95% confidence interval [CI], 0.47–0.98; p = 0.04) and immediate postoperative HB grade (odds ratio for one-grade increase of 0.27; 95% CI, 0.15–0.50; p < 0.001) to be jointly significantly associated with complete recovery to HB Grade I, indicating that the likelihood of complete facial nerve recovery was higher for younger patients and for those with better immediate postoperative HB grades. For example, the predicted probability of complete facial nerve recovery for a 30-year-old with immediate postoperative HB Grade III was 0.76 (or 76% when expressed as a percentage), whereas the predicted probability for a 50-year-old with immediate postoperative HB Grade V was only 0.10. Conclusions After considering immediate postoperative HB grade, younger age at surgery was independently significantly associated with complete facial nerve recovery, which can assist in intraoperative decision-making regarding extent of resection and postoperative counseling.

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Clinical Predictors of Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Cited by 23 publications

References 80 publications

Nomogram for Predicting Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Nomogram for Predicting Facial Nerve Outcomes After Surgical Resection of Vestibular Schwannoma

Hearing Preservation Microsurgery in Vestibular Schwannomas: Worth Attempting in “Larger” Tumors?

The Effect of Age on Facial Nerve Recovery After Vestibular Schwannoma Resection

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