Revision Surgery for Residual or Recurrent Vestibular Schwannoma

Freeman, Simon; Ramsden, R. T.; Saeed, Shakeel R; Alzoubi, Firas; Simó, Ricard; Rutherford, Scott A.; King, Andrew T.

doi:10.1097/mao.0b013e318159e76a

Cited by 45 publications

(34 citation statements)

References 19 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 In this series, several patients experienced moderate temporary postoperative facial nerve weakness. These patients recovered function after a period of time, but it is useful to note that there was a tempo- rary problem, possibly a result of intraoperative irritation of the facial nerve.…”

Section: Discussionmentioning

confidence: 99%

“…This is only slightly higher than the risk of regrowth for more complete resection, and not nearly as high as the risk of recurrence with other STR strategies. 3 All patients who later had regrowth of their tumors had initially been treated with a subtotal microsurgical resection. None of the patients treated with GTR required retreatment.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of suboptimal resection, revision surgery increases the risk of injuring the facial nerve, making a complete initial resection desirable. 3 Repeat operation is also associated with an increased risk of complications, including poor facial nerve outcome-only 50% of patients preserve their good facial nerve function. 3,13 In cases in which GKS fails and microsurgical resection is required, facial nerve preservation is 52%, a significant drop from the expected chance of facial nerve preservation with either treatment alone.…”

mentioning

confidence: 99%

“…3 Repeat operation is also associated with an increased risk of complications, including poor facial nerve outcome-only 50% of patients preserve their good facial nerve function. 3,13 In cases in which GKS fails and microsurgical resection is required, facial nerve preservation is 52%, a significant drop from the expected chance of facial nerve preservation with either treatment alone. 14 Patients in whom initial treatment (either radiosurgery or microsurgery) failed, who are re-treated with radiosurgery for their residual tumor, have had better outcomes; 90% of patients with good facial nerve function prior to radiosurgery had preservation of their facial function.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Haque

Wojtasiewicz²,

Gigante³

et al. 2011

JNS

View full text Add to dashboard Cite

Object. The goal of this article was to show that a combination of facial nerve-sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS).Methods. Records of individuals treated by a single surgeon with a facial nerve-sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.2%) of these patients required postoperative retreatment for a significant expansion of residual tumor after microsurgery. These 20 patients were re-treated with GKS.Results. The rate of preservation of good facial nerve function (Grade I or II on the House-Brackmann scale) in patients treated with microsurgery for VS was 97%. Both subtotal and gross-total resection had excellent facial nerve preservation rates (97% vs 96%), although subtotal resection carried a higher risk that patients would require retreatment. In patients re-treated with GKS after microsurgery, the rate of facial nerve preservation was 95%.Conclusions. In patients with tumors that cannot be managed with radiosurgery alone, a facial nerve-sparing resection followed by GKS for any significant regrowth provides excellent facial nerve preservation rates. (DOI: 10.3171/2011.7.JNS101921) key WoRDs • vestibular schwannoma • facial nerve • Gamma Knife surgery • tumor recurrence • peripheral nerve 917Abbreviations used in this paper: GKS = Gamma Knife surgery; GTR = gross-total resection; HB = House-Brackmann; IAC = internal auditory canal; NF2 = neurofibromatosis Type 2; STR = subtotal resection; VS = vestibular schwannoma.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Haque

Wojtasiewicz²,

Gigante³

et al. 2011

JNS

View full text Add to dashboard Cite

show abstract

“…Such patients tended to have worse outcomes, both before and after SRS. Freeman et al found that 8 (30%) of 27 patients who underwent 1 repeat resection underwent additional treatment for tumor progression, 10 indicating a tumor control rate after repeat resection of 70%.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

Huang

Kano

Mousavi

et al. 2017

Journal of Neurosurgery

View full text Add to dashboard Cite

V estibular schwannomas (VSs), also known as acoustic neuromas, are benign primary intracranial tumors that arise from the Schwann cells of the vestibulocochlear nerve. The incidence of VS is estimated to be 1 per 100,000 individuals per year, and it accounts for approximately 8% of all intracranial tumors in adults. 3,14 These tumors are typically slow growing (0-3.9 mm per year), but without management, most VS tumors will grow within 3 years. 4,6,14,15,18,20 For many years, microsurgical resection remained the most commonly recommended treatment for patients with newly diagnosed unilateral VS. 3,20 Although surgical outcomes have improved over the last 30 years, resection of VS was frequently associated with impaired facial nerve function and loss of hearing. 7,13,20,22 The recurrence rate of VS has been shown to be 2.6%-11.0% after gross-total resection, and 20%-50% of VS tumors progress after subtotal resection. 1,2,12,19,20,22,24,25,26,28 Since the development of the Gamma Knife (GK) technology, stereotactic radiosurgery (SRS) has become an increasingly used alternative or adjuvant VS management tool that eliminates many risks associated with resection.14,23 Initial SRS for VS has improved hearing retention rates in 60%-90% of patients and reduced facial neuropa-ABBREVIATIONS GK = Gamma Knife; G-R = Gardner-Robertson; HB = House-Brackmann; QOL = quality of life; SRS = stereotactic radiosurgery; VS = vestibular schwannoma. The Center for Image-Guided Neurosurgery and the Departments of 1 Neurological Surgery and 2 Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania OBJECTIVE The goal of this retrospective cohort study was to assess long-term outcomes in patients with vestibular schwannoma (VS) who underwent stereotactic radiosurgery (SRS) after initial microsurgical resection. METHODS From the authors' database of 1770 patients with VS, the authors retrospectively analyzed data from 173 Gamma Knife SRS procedures for VS after 1 (128 procedures) or multiple (45 procedures) microsurgical resections. The median length of the interval between the last resection and SRS was 42 months (range 2-329 months). The median length of clinical follow-up was 74 months (range 6-285 months). Progression-free survival after SRS was determined with Kaplan-Meier analysis. RESULTS At the time of SRS, the hearing of 161 patients (93%) was Gardner-Robertson Class V, and 81 patients (47%) had facial neuropathy (i.e., facial function with House-Brackmann [HB] grades of III-VI), 87 (50%) had trigeminal neuropathy, and 71 (41%) reported imbalance or disequilibrium disorders. The median tumor volume was 2.7 cm 3 (range 0.2-21.6 cm 3 ), and the median dose to the tumor margin was 13 Gy (range 11-20 Gy). Radiosurgery controlled growth of 163 (94%) tumors. Progression-free survival after SRS was 97% at 3 years, 95% at 5 years, and 90% at 10 years. Four patients with delayed tumor progression underwent repeat SRS at a median of 35 months (range 23-64 months) after the first SRS. Four patients (2.3%) w...

show abstract

Magnetic resonance imaging surveillance following vestibular schwannoma resection

et al. 2012

View full text Add to dashboard Cite

Persistent nonspecific radiologic enhancement within the postoperative field is common, making the diagnosis of tumor recurrence challenging. Factors including completeness of resection and baseline postoperative MRI findings provide valuable information regarding risk for recurrence, which may assist the clinician in determining an appropriate postoperative MRI surveillance schedule. Future studies using standardized terminology and consistent study metrics are needed to further refine surveillance recommendations.

show abstract

Revision Surgery for Residual or Recurrent Vestibular Schwannoma

Cited by 45 publications

References 19 publications

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

Magnetic resonance imaging surveillance following vestibular schwannoma resection

Contact Info

Product

Resources

About