Comparison of Clinical Characteristics and Surgical Outcomes of Cystic and Solid Vestibular Schwannomas

Han, Ji Hyuk; Baek, Kwang Ha; Lee, Young Woo; Hur, Young Kyun; Kim, Hyun Ji; Moon, In Seok

doi:10.1097/mao.0000000000001813

Cited by 11 publications

(20 citation statements)

References 25 publications

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Section: Resultsmentioning

confidence: 99%

“…It has been demonstrated that the volume increase of VS is not merely based on cell proliferation, but is also implicated with (neo)vascularization, intratumoral hemorrhage, cyst formation and inflammatory reaction (32,101,102). On the one hand, merlin initiates the Hippo pathway by directly activating mammalian STE20-like protein (MST1/2), which in turn phosphorylates large tumor suppressor homolog 1/2 (LATS1/2), or by recruiting LATS 1/2 to the plasma membrane for phosphorylation by MST1/2 kinases.…”

Section: Inflammatory Signalmentioning

confidence: 99%

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Potential Molecular Biomarkers of Vestibular Schwannoma Growth: Progress and Prospects

et al. 2021

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Vestibular schwannomas (VSs, also known as acoustic neuromas) are relatively rare benign brain tumors stem from the Schwann cells of the eighth cranial nerve. Tumor growth is the paramount factor for neurosurgeons to decide whether to choose aggressive treatment approach or careful follow-up with regular magnetic resonance imaging (MRI), as surgery and radiation can introduce significant trauma and affect neurological function, while tumor enlargement during long-term follow-up will compress the adjacent nerves and tissues, causing progressive hearing loss, tinnitus and vertigo. Recently, with the deepening research of VS biology, some proteins that regulate merlin conformation changes, inflammatory cytokines, miRNAs, tissue proteins and cerebrospinal fluid (CSF) components have been proposed to be closely related to tumor volume increase. In this review, we discuss advances in the study of biomarkers that associated with VS growth, providing a reference for exploring the growth course of VS and determining the optimal treatment strategy for each patient.

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Section: Resultsmentioning

confidence: 99%

Section: Inflammatory Signalmentioning

confidence: 99%

Potential Molecular Biomarkers of Vestibular Schwannoma Growth: Progress and Prospects

et al. 2021

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“…Large cystic VS account for 10-20% of all VS and are thought to be characterized by a more rapid growth and worse surgical outcome, mostly related to their larger size and greater adhesion to the surrounding tissues [54], and should be distinguished from solid VS.…”

Section: Introductionmentioning

confidence: 99%

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

et al. 2020

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Background and objective The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. Material and methods A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. Results Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. Conclusion The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.

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“…In our data, this discrepancy was likely due to cVS patients with worse long-term FN outcome versus most sVS patients, who improved in their long-term FN function. Compared with the existing literature, which focuses primarily on a single time point for follow-up, we demonstrate in our data that cVS patients trended toward worse outcomes even at their first postoperative follow-up appointments, which has important implications for FN rehabilitation and patient counseling 23 . It may be possible that during dissection of cystic tumors, there is an increased likelihood of traction injury to the surrounding cranial nerves (facial and cochleovestibular) as the cystic tumors are inherently more adherent.…”

Section: Discussionmentioning

confidence: 44%

“…Although cystic tumors were historically associated with worse FN outcomes, 6 recent studies have begun to question this traditional dogma 23–25 . These studies argue that differences in outcomes between cVS and sVS are likely secondary to differences in tumor volume rather than the presence of the cyst.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Outcomes in Cystic Versus Solid Vestibular Schwannoma in a Multi-institutional Cohort

Zhang,

Ostrander,

Duhon

et al. 2023

Otol Neurotol

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Objective Cystic vestibular schwannomas (cVSs) have more variable and less favorable clinical outcomes after microsurgical resection compared with solid VS (sVS). This study compares the preoperative presentation and postoperative outcomes between cVS and sVS. Study Design Retrospective cohort study. Setting Two tertiary skull base referral centers. Methods Consecutive adult patients who underwent VS resection from 2016 to 2021 were included. Univariate and multivariate analyses compared differences in baseline symptoms and postoperative outcomes between cVS and sVS. Results There were a total of 315 patients (64% female; mean age, 54 yrs) and 46 (15%) were cystic. cVS were significantly larger than sVS (maximum diameter, 28 vs. 18 mm, p < 0.001) and had higher rates of dysphagia and dysphonia preoperatively (p < 0.02). cVSs were more likely to undergo translabyrinthine resection (76 vs. 50%, p = 0.001) and have a higher rate of subtotal resection (STR) compared with sVS (30 vs. 13%, p = 0.003). At latest follow-up, fewer cVS achieved good facial nerve (FN) outcome (House-Brackmann [HB] I/II) (80 vs. 90%, p = 0.048). Subanalysis of cVS and sVS matched in tumor size, and surgical approach did not show differences in the rate of STR or FN outcomes (HB I/II, 82 vs. 78%, p = 0.79). Conclusion In this large multi-institutional series, cVSs represent a distinct entity and are characterized by larger tumor size and higher incidence of atypical symptoms. Although cVSs were more likely to undergo STR and portend worse FN outcomes than sVSs, this may be due to their larger tumor size rather than the presence of the cystic component.

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Comparison of Clinical Characteristics and Surgical Outcomes of Cystic and Solid Vestibular Schwannomas

Abstract: CVSs tend to be larger than SVSs. Tumor volume, not cystic component, is thought to be a major determinant of surgical outcomes.

Cited by 11 publications

References 25 publications

Potential Molecular Biomarkers of Vestibular Schwannoma Growth: Progress and Prospects

Potential Molecular Biomarkers of Vestibular Schwannoma Growth: Progress and Prospects

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

Comparison of Postoperative Outcomes in Cystic Versus Solid Vestibular Schwannoma in a Multi-institutional Cohort

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