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

Seol, Ho Jun; Kim, Choong Hyo; Park, Shin Young; Kim, Chi Heon; Kim, Dong-Gyu; Chung, Youngseob; Jung, Hee Won

doi:10.2176/nmc.46.176

Cited by 76 publications

(64 citation statements)

References 13 publications

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“…Although earlier literature clearly discouraged incomplete VS resection, 3,8,11 more recent publications suggest that less than total removal is an acceptable alternative, especially in cases of difficult tumor resections. 1,4,6,7,9,12 In the present study, we prospectively assessed 772 patients with VSs and found that despite short-term benefits (lower rates of recurrence in patients undergoing more aggressive resection), ultimately the rates of tumor recurrence are similar at long-term follow-up.…”

Section: Discussionmentioning

confidence: 72%

“…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%

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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: Discussionmentioning

confidence: 72%

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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“…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%

“…All vestibular schwannomas are managed in a multi-disciplinary team setting with decisions dependent on size of the tumour, the extent of hearing loss, patient co-morbidities and preferences. The principal aim is to minimise morbidity, preserving functions of surrounding structures, particularly the facial nerve [4,5].…”

Section: Introductionmentioning

confidence: 99%

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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“…Secondarily, the completeness of tumor removal is the ideal goal in surgery of a large VSs as shown in this case. A near total resection in which remnant within the IAC or adhering to facial nerve or brain stem would be an optional strategy in surgical resection of large VSs 14) . However, subtotal tumor removal with large residuals should be avoided due to high regrowth rates and requiring unplanned revision surgery with increased morbidity and mortality 4,8,13) .…”

Section: Discussionmentioning

confidence: 99%