Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery

Wise, Stephanie C.; Carlson, Matthew L.; Tveiten, Øystein Vesterli; Driscoll, Colin L. W.; Myrseth, Erling; Lund‐Johansen, Morten; Link, Michael J.

doi:10.1002/lary.25943

Cited by 60 publications

(35 citation statements)

References 29 publications

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“…Microsurgery after failed SRS maybe associated with worse cranial nerve outcomes and STR due to the poorer arachnoid planes surrounding the neurovascular structures following radiation [40,68,72,92,179]. However, others suggest no clear relationship between the use of SRS and the subsequent ease or difficulty of delayed microsurgery [91,132].…”

Section: Rescue Surgery For Large Vs After Srsmentioning

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: Rescue Surgery For Large Vs After Srsmentioning

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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“…We have found operating on VSs following SRS to be more difficult compared with radiation-naïve tumors, as have other busy VS centers; therefore we are not inclined to enthusiastically push patients in that direction. 7,8,11,22 Many in the radiosurgical community only consider SRS failure when surgical intervention becomes "necessary." Determining what necessary means may be quite different for different centers and for different patients.…”

Section: Figmentioning

confidence: 99%

Editorial: Vestibular schwannoma radiosurgery: progression or pseudoprogression?

Régis

Delsanti

Roche

2017

Journal of Neurosurgery

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“…In addition to the above some authors have claimed that an important risk factor related to CSF leak formation seems to be adjuvant RT [2, 6, 7, 27]. …”

Section: Discussionmentioning

confidence: 99%

Massive Cerebrospinal Fluid Leak of the Temporal Bone

Iannella¹,

Manno²,

Pasqualitto³

et al. 2016

Case Reports in Otolaryngology

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Cerebrospinal fluid (CSF) leakage of the temporal bone region is defined as abnormal communications between the subarachnoidal space and the air-containing spaces of the temporal bone. CSF leak remains one of the most frequent complications after VS surgery. Radiotherapy is considered a predisposing factor for development of temporal bone CSF leak because it may impair dural repair mechanisms, thus causing inadequate dural sealing. The authors describe the case of a 47-year-old man with a massive effusion of CSF which extended from the posterior and lateral skull base to the first cervical vertebrae; this complication appeared after a partial enucleation of a vestibular schwannoma (VS) with subsequent radiation treatment and second operation with total VS resection.

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Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery

Abstract: 3b. Laryngoscope, 126:2580-2586, 2016.

Cited by 60 publications

References 29 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

Editorial: Vestibular schwannoma radiosurgery: progression or pseudoprogression?

Massive Cerebrospinal Fluid Leak of the Temporal Bone

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