The Peculiar Cystic Vestibular Schwannoma: A Single-Center Experience

Metwali, Hussam; Samii, M.; Samii, Amir; Gerganov, Venelin

doi:10.1016/j.wneu.2014.07.011

Cited by 31 publications

(25 citation statements)

References 19 publications

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“…In contrast, the impact of cystic features on the extent of resection has varied in other series. 1,2,5,11 We also found that the extent of resection did not have an impact on facial nerve outcomes. This finding contrasts with those of Yashar et al, 3 who found facial nerve outcomes to be worse with cystic tumors undergoing more extensive resection.…”

Section: Facial Nerve Outcomesmentioning

confidence: 51%

“…It has been postulated that a poor dissection plane with the facial nerve or difficulty in defining the plane from the cyst wall contributes to the perceived worse facial nerve outcomes. Metwali et al 1 reported that medial thin-walled cysts were associated with worse facial nerve outcomes despite no difference in facial nerve outcome from solid tumors when comparing their entire cohort. In our study, all but 2 of the 27 patients with CVS had medial cysts, which prevented a meaningful comparison between patients who had a CVS with a medial cyst vs CVS without a medial cyst.…”

Section: Facial Nerve Outcomesmentioning

confidence: 99%

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Comparison of Surgical Outcomes and Recurrence Rates of Cystic and Solid Vestibular Schwannomas

Almefty

Mooney

et al. 2019

J Neurol Surg B Skull Base

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Objective Cystic vestibular schwannomas (CVSs) are anecdotally believed to have worse clinical and tumor-control outcomes than solid vestibular schwannomas (SVSs); however, no data have been reported to support this belief. In this study, we characterize the clinical outcomes of patients with CVSs versus those with SVSs. Design This is a retrospective review of prospectively collected data. Setting This study is set at single high-volume neurosurgical institute. Participants We queried a database for details on all patients diagnosed with vestibular schwannomas between January 2009 and January 2014. Main Outcome Measures Records were retrospectively reviewed and analyzed using univariate and multivariate analyses to study the differences in clinical outcomes and tumor progression or recurrence. Results Of a total of 112 tumors, 24% (n = 27) were CVSs and 76% (n = 85) were SVSs. Univariate analysis identified the extent of resection, Koos grade, and tumor diameter as significant predictors of recurrence (p ≤ 0.005). However, tumor diameter was the only significant predictor of recurrence in the multivariate analysis (p = 0.007). Cystic change was not a predictor of recurrence in the univariate or multivariate analysis (p ≥ 0.40). Postoperative facial nerve and hearing outcomes were similar for both CVSs and SVSs (p ≥ 0.47). Conclusion Postoperative facial nerve outcome, hearing, tumor progression, and recurrence are similar for patients with CVSs and SVSs. As CVS growth patterns and responses to radiation are unpredictable, we favor microsurgical resection over radiosurgery as the initial treatment. Our data do not support the commonly held belief that cystic tumors behave more aggressively than solid tumors or are associated with increased postoperative facial nerve deficits.

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Section: Facial Nerve Outcomesmentioning

confidence: 51%

Section: Facial Nerve Outcomesmentioning

confidence: 99%

Comparison of Surgical Outcomes and Recurrence Rates of Cystic and Solid Vestibular Schwannomas

Almefty

Mooney

et al. 2019

J Neurol Surg B Skull Base

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“…Considering preoperative severe facial weakness, complete tumor removal with FN reanimation could be a valuable option in some case. 29,39 In our second case although direct FN stimulation resulted in a weak response, we preferred to leave a small part of the tumor at the FN entry to the IAC to preserve the anatomical integrity of the nerve; nevertheless, the facial function did not improve postoperative. Therefore, we could recommend total tumor removal with FN reanimation (using sural nerve graft) if the nerve could not be stimulated intraoperatively.…”

Section: Discussionmentioning

confidence: 90%

“…Sudden deterioration of symptoms in a case of cystic VS is usually due to ITH. 28,29 The average growth rate in VS is 2 to 2.5 mm/year. 1 This slow growth rate represents an acceptable explanation of normal facial function even in cases of large VSs.…”

Section: Discussionmentioning

confidence: 99%

Chances of Improvement in Cases of Vestibular Schwannoma Presenting with Facial Nerve Weakness: Presentation of Two Cases and Literature Review

2018

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Background and Study Aim Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases. Methods and Results We are presenting two cases of VS with significant facial weakness. The first case was a 63-year-old male patient presented with 3 weeks' history of severe left-sided facial weakness (House–Brackmann [HB] grade V) and hearing loss. Magnetic resonance imaging (MRI) of the brain showed a tumor in the left internal auditory canal. Gross total removal with anatomical and physiological FN preservation was performed through a retrosigmoid approach under neurophysiological monitoring. FN function improved postoperatively to HB grade II after 16 months. The other case was 83-year-old male patient presented with sudden left-sided hearing loss and severe facial weakness (HB grade V). MRI of the brain 2.5 years before showed a left-sided (Class-T3A) cystic VS. The tumor was asymptomatic; wait-and-scan strategy was advised by the treating neurologist. Recent MRI of the brain showed approximately three times enlargement of the tumor with brain stem compression, extensive cystic changes, and suspected intratumoral hemorrhage. Surgery was performed; the tumor was subtotally removed through a retrosigmoid approach with intraoperative FN monitoring. The FN was anatomically preserved; however, physiological preservation was not possible. Severe facial weakness with incomplete lid closure persisted postoperatively. Conclusion Surgical treatment could be offered to cases of suspected VS presenting with facial weakness, as these cases may still have a chance for improvement especially in laterally located tumors.

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“…33 This was substantiated by Metwali et al who reported that postoperative VP shunting was more common among cystic than solid lesions of all sizes (8.1% vs 1.7%) for symptomatic hydrocephalus. 45 Conversely, Mehrotra et al reported that neither giant cystic nor giant solid lesions were more likely to present with post operative shunting. 43 …”

Section: Accepted Manuscriptmentioning

confidence: 99%

The Outcome of Hypofractionated Stereotactic Radiosurgery for Large Vestibular Schwannomas

Teo

Zhang

et al. 2016

World Neurosurgery

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The Peculiar Cystic Vestibular Schwannoma: A Single-Center Experience

Cited by 31 publications

References 19 publications

Comparison of Surgical Outcomes and Recurrence Rates of Cystic and Solid Vestibular Schwannomas

Comparison of Surgical Outcomes and Recurrence Rates of Cystic and Solid Vestibular Schwannomas

Chances of Improvement in Cases of Vestibular Schwannoma Presenting with Facial Nerve Weakness: Presentation of Two Cases and Literature Review

The Outcome of Hypofractionated Stereotactic Radiosurgery for Large Vestibular Schwannomas

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