Long-term follow-up of the residual intracanalicular tumours after subtotal removal of acoustic neurinomas

Kameyama, Shigeki; Tanaka, Ryuichi; Kawaguchi, Tadashi; Honda, Yuji; Yamazaki, Hidetoshi; Hasegawa, Akira

doi:10.1007/bf01411362

Cited by 30 publications

(28 citation statements)

References 15 publications

(24 reference statements)

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“…In this paradigm, treatment of large, adherent tumors could consist of surgery with a goal of at least reducing the tumor to a size suitable for stereotactic radiosurgery in the future and removing as much tumor as can be safely removed, while preventing iatrogenic injury to the facial and cochlear nerves in difficult cases. 1,4,6,7,9,12 In the present study we provide tumor control data acquired in a cohort of 772 patients who underwent VS surgery during a 25-year period and who were prospectively followed for many years postoperatively. Through this analysis, we critically analyze the effect of strategically leaving small amounts of residual tumor behind, in an attempt to avoid neurological injury.…”

Section: 1013-19mentioning

confidence: 99%

Extent of resection and the long-term durability of vestibular schwannoma surgery

Sughrue¹,

Kaur²,

Rutkowski³

et al. 2011

JNS

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Object. With limited studies available, the correlation between the extent of resection and tumor recurrence in vestibular schwannomas (VSs) has not been definitively established. In this prospective study, the authors evaluated 772 patients who underwent microsurgical resection of VSs to analyze the association between total tumor resection and the tumor recurrence rate.Methods. The authors selected all cases from a prospectively collected database of patients who underwent microsurgical resection as their initial treatment for a histopathologically confirmed VS. Recurrence-free survival was analyzed using Kaplan-Meier analysis. The authors studied the impact of possible confounders such as patient age and tumor size using stepwise Cox regression to calculate the proportional hazard ratio of recurrence while controlling for other cofounding variables.Results. The authors analyzed data obtained in 571, 89, and 112 patients in whom gross-total, near-total, and subtotal resections, respectively, were performed. A gross-total resection was achieved in 74% of the patients, and the overall recurrence rate in these patients 8.8%. There was no significant relation between the extent of resection and the rate of tumor recurrence (p = 0.58). As expected, the extent of resection was highly correlated with patient age, tumor size, and surgical approach (p < 0.0001). Using Cox regression, the authors found that the approach used did not significantly affect tumor control when the extent of resection was controlled for.Conclusions. While complete tumor removal is ideal, the results presented here suggest that there is no significant relationship between the extent of resection and tumor recurrence. (DOI: 10.3171/2010.11.JNS10257) KeY worDS • vestibular schwannoma • acoustic neuroma • microsurgery • recurrence • gross tumor resectionAbbreviations used in this paper: GTR = gross-total resection; HR = hazard ratio; NTR = near-total resection; STR = subtotal re section; VS = vestibular schwannoma.

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Section: 1013-19mentioning

confidence: 99%

Extent of resection and the long-term durability of vestibular schwannoma surgery

Sughrue¹,

Kaur²,

Rutkowski³

et al. 2011

JNS

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“…However, cellularity and vascularity also affect growth rate. 8,9) Vascularization occurs due to tumor angiogenesis within VS larger than 2 cm. The principal factor affecting the postoperative growth potential of residual tumor is vascularity rather than cellularity.…”

Section: Tumor Recurrencementioning

confidence: 99%

“…The principal factor affecting the postoperative growth potential of residual tumor is vascularity rather than cellularity. 9) The low recurrence rate of intracanalicular residual tumor is attributed to the devascularizing effect of surgery.…”

Section: Tumor Recurrencementioning

confidence: 99%

“…The correlation between postoperative facial nerve function and tumor size is generally accepted. 7,9) The incidence of facial nerve palsy was 80% for tumors greater than 2 cm in diameter. 11) The incidence of postoperative facial nerve paresis or paralysis was 46% for large tumors greater than 3 cm in diameter.…”

Section: Facial Nerve Preservationmentioning

confidence: 99%

“…5,12) However, several recent studies have indicated that incomplete resection is not associated with a significant increase in recurrence rate. 5,9,10,12) This retrospective study examined the recurrence rate and postoperative facial nerve function in relation to the extent of surgical resection.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Seol

Kim

Park

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. The extent of resection was classified as follows: gross total resection (GTR), near total resection (NTR), and subtotal resection (STR). Facial nerve function was graded using the modified House-Brackmann grade, and patients grouped into good (grades 1-2) and intermediate or poor (grades 3-6). Of the 116 patients, 26 (22%) underwent GTR, 32 (28%) NTR, and 58 (50%) STR. The recurrence rates were 3.8% (1/26 cases), 9.4% (3/32), and 27.6% (16/58) for GTR, NTR, and STR, respectively. GTR and NTR showed no statistically significant difference in terms of recurrence rate (p ＝ 0.620). However, recurrence was significantly less after NTR than STR (p ＝ 0.043). Immediately postoperative facial nerve function was good in 15.4% of patients after GTR, 40.6% after NTR, and 46.6% after STR. The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p ＝ 0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p ＝ 0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.

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Volumetric analysis of tumor control following subtotal and near‐total resection of vestibular schwannoma

et al. 2015

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Long-term follow-up of the residual intracanalicular tumours after subtotal removal of acoustic neurinomas

Cited by 30 publications

References 15 publications

Extent of resection and the long-term durability of vestibular schwannoma surgery

Extent of resection and the long-term durability of vestibular schwannoma surgery

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Volumetric analysis of tumor control following subtotal and near‐total resection of vestibular schwannoma

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