Facial Nerve Outcome and Tumor Control Rate as a Function of Degree of Resection in Treatment of Large Acoustic Neuromas

Monfared, Ashkan; Corrales, C. Eduardo; Theodosopoulos, Philip V.; Blevins, Nikolas H.; Oghalai, John S.; Selesnick, Samuel H.; Lee, Howard; Gurgel, Richard K.; Hansen, Marlan R.; Nelson, Rick F.; Gantz, Bruce J.; Kutz, Joe Walter; Isaacson, Brandon; Roland, Peter S.; Amdur, Richard L.; Jackler, Robert K.

doi:10.1227/neu.0000000000001162

Cited by 128 publications

(92 citation statements)

References 24 publications

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“…To minimize the risk of FN paralysis during surgery on large VS, subtotal resection (STR) and near-total resection (NTR) are being performed more frequently, followed by stereotactic radiosurgery upfront or when the tumor remnant is found to be growing during radiological follow-up. NTR seems to be better than STR in terms of tumor control, as shown recently by Monfared et al; 24 in their study, they observed a rate of VS regrowth that was 3 times higher in patients who underwent STR compared with those who underwent gross-total resection (GTR) or NTR. The authors did not explain in detail the reasons for having performed STR, apart from "the surgeon's discretion considering intraoperative findings such as tumor adherence."…”

supporting

confidence: 56%

“…The authors did not explain in detail the reasons for having performed STR, apart from "the surgeon's discretion considering intraoperative findings such as tumor adherence." 24 The risk factors for tumor regrowth have largely been studied in other retrospective investigations: the extent of resection 6,11,17,20,24,26,28 seems to be the most reported prognostic factor; when taking into consideration measurements based on postoperative MRI and not on surgical observations, tumor remnants thicker than 7.4 mm 17 or with volume greater than 2.5 cm 3, 28 have a significantly higher rate of recurrence.…”

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confidence: 99%

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Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas

Bernardeschi

Pyatigorskaya

Vanier

et al. 2018

Journal of Neurosurgery

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OBJECTIVE In large vestibular schwannoma (VS) surgery, the facial nerve (FN) is at high risk of injury. Near-total resection has been advocated in the case of difficult facial nerve dissection, but the amount of residual tumor that should be left and when dissection should be stopped remain controversial factors. The objective of this study was to report FN outcome and radiological results in patients undergoing near-total VS resection guided by electromyographic supramaximal stimulation of the FN at the brainstem. METHODS This study was a retrospective analysis of a prospectively maintained database. Inclusion criteria were surgical treatment of a large VS during 2014, normal preoperative FN function, and an incomplete resection due to the strong adherence of the tumor to the FN and the loss of around 50% of the response of supramaximal stimulation of the proximal FN at 2 mA. Facial nerve function and the amount and evolution of the residual tumor were evaluated by clinical examination and by MRI at a mean of 5 days postoperatively and at 1 year postoperatively. RESULTS Twenty-five patients met the inclusion criteria and were included in the study. Good FN function (Grade I or II) was observed in 16 (64%) and 21 (84%) of the 25 patients at Day 8 and at 1 year postoperatively, respectively. At the 1-year follow-up evaluation (n = 23), 15 patients (65%) did not show growth of the residual tumor, 6 patients (26%) had regression of the residual tumor, and only 2 patients (9%) presented with tumor progression. CONCLUSIONS Near-total resection guided by electrophysiology represents a safe option in cases of difficult dissection of the facial nerve from the tumor. This seems to offer a good compromise between the goals of preserving facial nerve function and achieving maximum safe resection.

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confidence: 56%

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confidence: 99%

Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas

Bernardeschi

Pyatigorskaya

Vanier

et al. 2018

Journal of Neurosurgery

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“…28,29 However, in a recent preliminary report of a large prospective multicenter study, Monfared et al found that four of 11 (36%) cases failed salvage radiation therapy, leading to the conclusion that radiation control of growing tumor remnants following microsurgery is suboptimal. 30 Our study has several strengths and limitations. We included a relatively large and homogenous cohort of sporadic VS and excluded patients with NF2 given the significant difference in tumor biology and behavior.…”

Section: Discussionmentioning

confidence: 97%

“…Several studies have demonstrated that the results following subtotal resection are on par with primary radiation treatment . However, in a recent preliminary report of a large prospective multicenter study, Monfared et al found that four of 11 (36%) cases failed salvage radiation therapy, leading to the conclusion that radiation control of growing tumor remnants following microsurgery is suboptimal …”

Section: Discussionmentioning

confidence: 99%

Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery

et al. 2016

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“…The rate of radiation control of growing remnants is questionable. [28] In addition, microsurgery after radiosurgery in case of tumor regrowth becomes even more challenging and is associated with higher complication rates. [14]…”

Section: Discussionmentioning

confidence: 99%

Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

Harati¹,

Scheufler²,

Schultheiß³

et al. 2017

Surg Neurol Int

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Background:Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression.Methods:Forty-nine patients presented with VS (Hannover grading scale T4a or T4b) in our department. A subgroup analysis was performed among patients without (T4a) and with (T4b) compression and dislocation of the fourth ventricle.Results:Patients with type T4b VS presented significantly more often with long tract signs/ataxia (P < 0.05), tonsillar herniation (P < 0.001), and preoperative hydrocephalus (P < 0.01). No significant difference was found between the groups regarding hearing loss and facial nerve, trigeminal nerve, and lower cranial nerve function. Gross total resection was achieved in 83% of the cases, near total resection was achieved in 15% of the cases, and subtotal resection was performed in 2% of the cases. One patient died after massive postoperative bleeding caused by a coagulopathy. At last follow-up, 69% of the patients had excellent facial nerve function (Grade I–II) and the remaining 31% a fair outcome. Six patients (12%) required permanent ventriculoperitoneal shunting. Hearing was preserved in two patients. Forty-six patients (94%) were independent without occasional assistance (Karnofsky scale 70–100%).Conclusions:VS with brainstem compression is frequently associated with hydrocephalus, ataxia, long tract signs, multiple cranial nerve disorders, and occasionally, signs of intracranial hypertension. Primary microsurgical resection is an appropriate management option for large VS.

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Facial Nerve Outcome and Tumor Control Rate as a Function of Degree of Resection in Treatment of Large Acoustic Neuromas

Abstract: CNVII, cranial nerve VIIGTR, gross total resectionHB, House-BrackmannMRI, magnetic resonance imageNTR, near total resectionSTR, subtotal resection.

Cited by 128 publications

References 24 publications

Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas

Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas

Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery

Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression

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