Management of Large and Giant Vestibular Schwannomas

Pai, Irumee; Bowman, James; Thomas, Nick; Kitchen, Neil; Strong, Anthony J.; Obholzer, Rupert; Gleeson, Michael

doi:10.1055/s-0031-1287680

Cited by 16 publications

(23 citation statements)

References 18 publications

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“…Seven out of 16 (44 %) had further intervention in the form of stereotactic surgery (STS) or repeat microsurgery indicating that patients undergoing subtotal resection are likely to require adjuvant therapy or repeat surgery. This is in contrast to recently published literature indicating that extent of resection has little effect on the recurrence rate [6,9]. This may, in part, be due not only to larger tumours in this subgroup but also cystic or mixed tumour pathologies.…”

Section: Discussioncontrasting

confidence: 99%

“…Management depends on tumour size, ability to preserve cranial nerve function, extent of hearing loss, patient preference and co-morbidities [1,[4][5][6]8].…”

Section: Discussionmentioning

confidence: 99%

“…Despite progress in the understanding and management of vestibular schwannomas, there remain discrepancies and uncertainties regarding optimal patient outcomes [6]. Whilst historically the main aim was for complete tumour removal, this has now been superseded with achieving the best patient outcome-by optimising post-operative cranial nerve function whilst safeguarding for tumour re-growth [5].…”

Section: Introductionmentioning

confidence: 99%

“…It is difficult to correlate the results of the many studies comparing gross total, near total and subtotal resections, and use them to outline management as there is disparity between the limits, despite internationally agreed guidelines [6,10]. There is also no volumetric software in place for regular assessment of patients to elucidate these limits [6,11].…”

Section: Introductionmentioning

confidence: 99%

“…There is also no volumetric software in place for regular assessment of patients to elucidate these limits [6,11].…”

Section: Introductionmentioning

confidence: 99%

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Tumour Resection Volumes and Facial Nerve Outcomes for Vestibular Schwannomas

Virk

Tripathi

Randhawa

et al. 2014

Indian J Otolaryngol Head Neck Surg

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The objective of this study is to correlate tumour volume relationship with surgical outcomes in subtotal resections and accepted nomenclature through a retrospective study at Charing Cross Hospital, London, a tertiary referral centre. The participants were 16 patients with vestibular schwannoma managed with subtotal resection between 2002 and 2011. The main outcome measures were surgical technique; tumour volume; recurrence and post-operative facial nerve function. Mean preoperative and post-operative volumes for all patients were 14.7 and 3.7 cm 3 respectively. Tumour volumes do not correlate with diameter (p \ 0.05). Mean reduction in volume of these subtotal resections was 75 %. Long term facial nerve outcome was good in the majority of patients: House-Brackmann Grade I/II in 12 (75 %), Grade III/IV in 2 (12.5 %) and Grade V/VI in 2 patients (12.5 %). Notably, two patients with Grade I/II House-Brackmann grading later developed Grade V/VI palsy following adjunctive radiotherapy. Seven of the 16 subtotal resections had subsequent radiotherapy or microsurgery. Mean follow up was 26.5 months. In conclusion, subtotal resections lead to good facial nerve outcomes but may require further treatments. Radiation treatment can worsen facial nerve function. There is no standardised use of tumour volumes or accepted guidelines for resection terminology. We propose the use of tumour volumes to define this further.

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Section: Discussioncontrasting

confidence: 99%

“…Management depends on tumour size, ability to preserve cranial nerve function, extent of hearing loss, patient preference and co-morbidities [1,[4][5][6]8].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…There is also no volumetric software in place for regular assessment of patients to elucidate these limits [6,11].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Tumour Resection Volumes and Facial Nerve Outcomes for Vestibular Schwannomas

Virk

Tripathi

Randhawa

et al. 2014

Indian J Otolaryngol Head Neck Surg

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Outcomes of Near‐Total and Subtotal Resection of Sporadic Vestibular Schwannoma: A Systematic Review and Meta‐Analysis

Kocharyan,

Daher,

Curry

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo evaluate tumor control and facial nerve outcomes after gross‐total (GTR), near‐total (NTR), and subtotal resection (STR) of sporadic vestibular schwannomas (VS).Data SourcesPubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched in August 2021 through inception following PRISMA guidelines.Review MethodsEnglish language articles reporting tumor control and facial nerve outcomes of adults (≥18 years) with NTR and STR of VS were evaluated. Study characteristics, demographics data, tumor characteristics, type of surgical intervention, and outcome measures on tumor control and facial nerve function were collected. Pooled relative risk (RR) estimates for tumor recurrence and facial nerve outcomes were calculated and stratified by extent of resection.ResultsFrom an initial search of 2504 articles, 48 studies were included in the analysis. When comparing 1108 patients who underwent NTR to 3349 patients with GTR, the pooled RR of recurrence in the NTR cohort was 2.94 (95% confidence interval [CI] 1.65‐5.24, P = .0002). When comparing 1016 patients who underwent STR to 6171 patients with GTR, the pooled RR of recurrence in the STR cohort was 11.50 (95% CI 6.64‐19.92, P < .0001). Estimates for risk of tumor regrowth for less‐than‐complete resection are presented. There was no elevated risk of adverse facial nerve outcome (defined as House‐Brackmann grade III and above) in each category of extent of resection compared to GTR.ConclusionExtent of resection predicts risk of tumor recurrence/regrowth following microsurgical resection. Favorable facial nerve outcome should be weighed against the increased risk of regrowth and the potential need for further treatment.

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