Magnetic resonance imaging surveillance following vestibular schwannoma resection

Carlson, Matthew L.; Abel, Kathryn M. Van; Driscoll, Colin L. W.; Neff, Brian A.; Beatty, Charles W.; Lane, John I.; Castner, Marina L.; Lohse, Christine M.; Link, Michael J.

doi:10.1002/lary.22411

Cited by 79 publications

(79 citation statements)

References 30 publications

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“…Residual postoperative tumor thickness of 10.9 ± 4.1 mm versus 5.7 ± 3.0 mm has been shown to be a risk factor for regrowth (p < 0.001). 19 Carlson et al 6 reported that in 350 patients with VSs treated with microsurgical resection, patients receiving STR were more than 9 times more likely to experience recurrence compared with those undergoing NTR or GTR (p < 0.001). Whereas GTR is optimal to prevent tumor recurrence, NTR appears to provide similarly low recurrence rates, likely due to a lack of adequate blood supply or critical tumor mass following NTR to allow subsequent growth.…”

Section: Extent Of Resectionmentioning

confidence: 99%

Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

Gurgel

Doğru

Amdur³

et al. 2012

FOC

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Object The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. Methods A PubMed search was conducted of English language studies on the treatment of large VSs published from 1985 to 2011. Studies were then evaluated and included if they contained data regarding the size of the tumor, surgical approach, extent of resection, and postoperative facial nerve function. Results Of the 536 studies initially screened, 59 full-text articles were assessed for eligibility, and 30 studies were included for analysis. A total of 1688 tumor resections were reported. Surgical approach was reported in 1390 patients and was significantly associated with facial nerve outcome (ϕ= 0.29, p < 0.0001). Good facial nerve outcomes (House-Brackmann Grade I or II) were produced in 62.5% of the 555 translabyrinthine approaches, 65.2% of the 601 retrosigmoid approaches, and 27.4% of the 234 extended translabyrinthine approaches. Facial nerve outcomes from translabyrinthine and retrosigmoid approaches were not significantly different from each other, but both showed significantly more good facial nerve outcomes, compared with the extended translabyrinthine approach (OR for translabyrinthine vs extended translabyrinthine = 4.43, 95% CI 3.17–6.19, p < 0.0001; OR for retrosigmoid vs extended translabyrinthine = 4.98, 95% CI 3.57–6.95, p < 0.0001). There were 471 patients for whom extent of resection was reported. There was a strong and significant association between degree of resection and outcome (ϕ= 0.38, p < 0.0001). Of the 80 patients receiving subtotal resections, 92.5% had good facial nerve outcomes, compared with 74.6% (n = 55) and 47.3% (n = 336) of those who received near-total resections and gross-total resections, respectively. In the 2-way comparison of good versus suboptimal/poor outcomes (House-Brackmann Grade III–VI), subtotal resection was significantly better than near-total resection (OR = 4.21, 95% CI 1.50–11.79; p = 0.004), and near-total resection was significantly better than gross-total resection (OR = 3.26, 95% CI 1.71–6.20; p = 0.0002) in producing better facial nerve outcomes. Conclusions In a pooled patient population from studies evaluating the treatment of large VSs, subtotal and near-total resections were shown to produce better facial nerve outcomes when compared with gross-total resections. The translabyrinthine and retrosigmoid surgical approaches are likely to result in similar rates of good facial nerve outcomes. Both of these approaches show better facial nerve outcomes when compared with the extended translabyrinthine approach, which is typically reserved for especially large tumors. The reported literature on treatment of large VSs is extremely heterogeneous and minimal consistency in reporting outcomes was observed.

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Section: Extent Of Resectionmentioning

confidence: 99%

Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

Gurgel

Doğru

Amdur³

et al. 2012

FOC

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“…15 Resection can be classified as gross total if there is no visible tumor remaining, near total if the remaining tumor dimensions are less than 5 × 5 × 2 mm, and subtotal if the remaining tumor is larger than that achieved after near-total resection. 4 Alternatively, neartotal resection can be designated as incomplete removal with less than 5% residual tumor volume and subtotal resection as greater than 5% of the original tumor volume. 7 Subtotal resection is associated with a 9 times greater likelihood of tumor recurrence compared with gross-total resection.…”

Section: Surgical Approachesmentioning

confidence: 99%

“…7 Subtotal resection is associated with a 9 times greater likelihood of tumor recurrence compared with gross-total resection. 4 Magnetic resonance imaging is routinely performed after resection, mainly to assess for residual or recurrent tumor, as well as suspected complications. A typical postoperative MRI examination consists of an internal auditory canal protocol that includes thin-section axial precontrast T1-weighted imaging, axial and coronal thinsection postcontrast fat-suppressed T1-weighted imaging, T2-weighted fast spin echo, T2-weighted FLAIR, diffusion-weighted imaging, and cisternography sequences, such as CISS (constructive interference in steady state) or FIESTA (fast imaging employing steady-state acquisition), at the level of the cerebellopontine angle.…”

Section: Surgical Approachesmentioning

confidence: 99%

“…4) corresponding to scar and/or granulation tissue in the surgical bed is apparent on MRI in the majority of cases during the first 6 postoperative months and can persist for 1 year or longer. 2,4 On the other hand, the presence of nodular enhancement (Fig. 5) on the initial postoperative MRI studies is associated with a 16-fold higher risk for eventual recurrence compared with a linear pattern of enhancement.…”

Section: Surgical Approachesmentioning

confidence: 99%

“…5) on the initial postoperative MRI studies is associated with a 16-fold higher risk for eventual recurrence compared with a linear pattern of enhancement. 4 It is also important to assess the entire extent of the surgical approach for nodular enhancement that may represent intraoperative tumor seeding (Fig. 6).…”

Section: Surgical Approachesmentioning

confidence: 99%

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Postoperative imaging of vestibular schwannomas

Ginat¹,

Martuza

2012

FOC

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Symptomatic vestibular schwannomas can be treated with resection (translabyrinthine, retrosigmoid [suboccipital], or middle cranial fossa approaches) or stereotactic radiosurgery. When appropriate, auditory brainstem stimulators can also be implanted in patients with current or impending hearing loss due to bilateral vestibular schwannomas. Imaging plays a prominent role in determining management following these procedures. In this article, the expected postoperative imaging appearances are depicted. The radiological features of complications are also reviewed, including recurrent tumor, fat graft necrosis, CSF leakage, infection, hydrocephalus, cerebral infarction, venous sinus thrombosis, hemorrhage, and temporal lobe and cerebellar contusions.

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Salvage Microsurgery Following Failed Primary Radiosurgery in Sporadic Vestibular Schwannoma

Marinelli,

Herberg,

Moore

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceManagement of sporadic vestibular schwannoma with radiosurgery is becoming increasingly common globally; however, limited data currently characterize patient outcomes in the setting of microsurgical salvage for radiosurgical failure.ObjectiveTo describe the clinical outcomes of salvage microsurgery following failed primary stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) among patients with sporadic vestibular schwannoma.Design, Setting, and ParticipantsThis was a cohort study of adults (≥18 years old) with sporadic vestibular schwannoma who underwent salvage microsurgery following failed primary SRS/FSRT in 7 vestibular schwannoma treatment centers across the US and Norway. Data collection was performed between July 2022 and January 2023, with data analysis performed between January and July 2023.ExposureSalvage microsurgical tumor resection.Main Outcomes and MeasuresComposite outcome of undergoing less than gross total resection (GTR) or experiencing long-term facial paresis.ResultsAmong 126 patients, the median (IQR) age at time of salvage microsurgery was 62 (53-70) years, 69 (55%) were female, and 113 of 117 (97%) had tumors that extended into the cerebellopontine angle at time of salvage. Of 125 patients, 96 (76%) underwent primary gamma knife SRS, while 24 (19%) underwent linear accelerator-based SRS; the remaining patients underwent FSRT using other modalities. Postoperative cerebrospinal fluid leak was seen in 15 of 126 patients (12%), hydrocephalus in 8 (6%), symptomatic stroke in 7 (6%), and meningitis in 2 (2%). Each 1-mm increase in cerebellopontine angle tumor size was associated with a 13% increased likelihood of foregoing GTR (64 of 102 patients [63%]) or long-term postoperative House-Brackmann grade higher than I (48 of 102 patients [47%]) (odds ratio, 1.13; 95% CI, 1.04-1.23). Following salvage microsurgery, tumor growth–free survival rates at 1, 3, and 5 years were 97% (95% CI, 94%-100%), 93% (95% CI, 87%-99%), and 91% (95% CI, 84%-98%), respectively.ConclusionsIn this cohort study, more than half of patients who received salvage microsurgery following primary SRS/FSRT underwent less than GTR or experienced some degree of facial paresis long term. These data suggest that the cumulative risk of developing facial paresis following primary SRS/FSRT by the end of the patient’s journey with treatment approximates 2.5% to 7.5% when using published primary SRS/FSRT long-term tumor control rates.

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Magnetic resonance imaging surveillance following vestibular schwannoma resection

Cited by 79 publications

References 30 publications

Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

Postoperative imaging of vestibular schwannomas

Salvage Microsurgery Following Failed Primary Radiosurgery in Sporadic Vestibular Schwannoma

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