Predictive Factors of Early Postoperative and Long-Term Facial Nerve Function After Large Vestibular Schwannoma Surgery

Troude, Lucas; Montava, Marion; Lavieille, Jean‐Pierre; Régis, J.; Roche, Pièrre-Hugues

doi:10.1016/j.wneu.2019.03.218

Cited by 45 publications

(35 citation statements)

References 25 publications

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“…The pooled overall GTR rate was 77% (95% CI 70.6–83.3%) in large series of large VS (Fig. 1 ) [ 2 , 13 , 14 , 17 , 19 , 25 , 26 , 30 , 33 – 35 , 47 , 64 , 66 , 76 , 77 , 88 , 97 , 99 , 100 , 104 , 109 , 119 , 134 , 137 , 138 , 142 , 145 , 147 , 152 , 156 , 160 , 161 , 166 , 169 , 177 , 180 , 181 , 186 – 190 ]. Notably, high-volume hospitals and surgeon caseload have been associated with decreased mortality, decreased postoperative complications and readmission rate, and better oncological and functional outcome [ 7 , 8 ] (Fig.…”

Section: Growth Pattern and Measurement Of Tumor Sizementioning

confidence: 99%

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

et al. 2020

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Background and objective The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. Material and methods A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. Results Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. Conclusion The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.

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Section: Growth Pattern and Measurement Of Tumor Sizementioning

confidence: 99%

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

et al. 2020

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“…Prior studies have demonstrated that larger tumors have worse facial nerve outcomes. [5][6][7][8][9][10][11][12] Recently, evidence has suggested that tumor volume may be a more accurate when assessing tumor progression. 13 While multiple studies correlated tumor diameter to facial nerve outcomes, fewer studies have suggested worse facial nerve outcomes with larger tumor volumes.…”

Section: Introductionmentioning

confidence: 99%

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

et al. 2020

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Objective: To explore the relationship between tumor size and facial nerve outcomes following vestibular schwannoma (VS) resection. Study Design: Single institutional retrospective chart review of all adult patients with untreated sporadic VS who underwent surgical resection from 2008 to 2018 with preoperative magnetic resonance imaging (MRI) and 1 year of follow-up. The primary outcome measure was facial nerve outcome as assessed by the House-Brackmann facial nerve grading system. Results: One hundred sixty-seven patients, 54.5% female, with a median age of 49 years (20-76 years), were identified who underwent VS resection. Surgical resection was performed by translabyrinthine (76.7%), middle cranial fossa (14.4%), retrosigmoid (7.2%), and transpromontorial (1.8%) approaches. The median tumor diameter and volume were 25.3 mm (range: 4.1-47.1 mm) and 3.17 cm 3 (range: 0.01-30.6 cm 3), respectively. The median follow-up was 24.2 months (range: 12-114.2 months). Gross total resection was performed in 79% of cases, with residual tumor identified on MRI in 17% of cases. For patients with tumors <3 cm 3 , 92.7% had grade 1 or 2 facial function after at least 1 year follow-up, compared to 81.2% for those with tumors >3 cm 3 (univariate logistic regression OR = 2.9, P = .03). Tumor volume >3 cm 3 was predictive of facial weakness on multivariate regression analysis (OR = 7.4, P = .02) when controlling for surgical approach, internal auditory canal extension, anterior extension, age, gender, and extent of resection. Conclusions: Tumor volume >3 cm 3 is associated with worse facial nerve outcomes 12 months following surgical resection.

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“…However, Iwai et al (22) found that optimal FN outcome (HBI-II postoperative rate of 95%) could be jeopardized by the need for salvage surgery after Gamma Knife in case of large tumor remnants (at least 6cm 3 ). Such ndings underline that radiosurgery is not an enemy of microsurgery (13,56), even if surgical removal should be attempted with the objective of maximal safe tumor eradication.…”

Section: Statistical Analysis Demonstrated a Signi Cant Correlation Bmentioning

confidence: 99%

“…Increasingly popular is the concept of the planned less-than-total resection performed for FN preservation (52). According to some authors (22,56,66) outcome might be improved in selected cases by a combined surgical and radiosurgical treatment. Zumofen et al (66) reported HBI-II postoperative rate of 89%, with no need for salvage surgery after Gamma Knife had been administered onto planned tumor residues.…”

Section: Statistical Analysis Demonstrated a Signi Cant Correlation Bmentioning

confidence: 99%

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

Mastronardi

Campione

Boccacci

et al. 2021

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Purpose Koos Grade IV vestibular schwannomas (VS) (maximum diameter >3cm) compress the brainstem and displace the fourth ventricle. Microsurgical resection with attention to the right balance between preservation of function and maximal tumour removal is the treatment of choice.Methods Our series consists of 60 consecutive patients with unilateral VS, operated on from December 2010 to July 2019. All patients underwent microsurgical removal via the retrosigmoid approach. The adherence of VS’ capsule to surrounding nervous structures and the excessive tendency of tumor to bleed during debulking, because of a redundant vascular architecture, was evaluated by reviewing video records. Microsurgical removal of tumor was classified as total (T), near-total (NT: residue<5%), subtotal (ST: residue 5-10%) or partial (P: residue>10%).Results Maximal mean tumor diameter was 3,97cm (SD±1,13; range 3,1-5,8cm). Preoperative severely impaired hearing or deafness (AAO-HNS Classes C-D) was present in 52 cases (86,7%). Total or NT resection was accomplished in 46 cases (76,7%), 65,8% in cases with and 95,4% without tight adhesion of capsule to nervous structures (p<0,001). Endoscopic-assisted microsurgical removal of VS in the IAC was performed in 23 patients: in these cases a T resection was obtained in 78,3% versus 45,9% of microsurgery only (p<0,001).The capsule of VS was tightly adherent to nervous structures in 63,3% of patients, whereas hypervascular high-bleeding tumors represented 56,7%. Hearing preservation was possible in 2 out of 8 patients with preoperative class B hearing. At last follow-up, 34 patients (56,7%) had a normal postoperative FN outcome (HBI), 9 (15,0%) were HBII, 8 (13,3%) HBIII, and 9 (15,0%) HBIV. Total-NT resection of solid and low-bleeding VS, without tight capsule adhesion was associated with better FN outcome. Mortality was zero; permanent complications were observed in 2 cases (diplopia, hydrocephalus), transient in 9.Conclusions Microsurgery of Koos Grade IV VS seems to be associated with more than acceptable functional results, with high rate of T and NT removal of tumor. Long-term FN results seem to be worse in patients with cystic Koos Grade IV VS, in cases with tight capsule adherences to nervous structures and in high-bleeding tumors.

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Predictive Factors of Early Postoperative and Long-Term Facial Nerve Function After Large Vestibular Schwannoma Surgery

Cited by 45 publications

References 25 publications

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

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Predictive Factors of Early Postoperative and Long-Term Facial Nerve Function After Large Vestibular Schwannoma Surgery

Cited by 45 publications

References 25 publications

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between&nbsp;Preservation of Function and Maximal Tumor Removal

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Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal