Vestibular Schwannoma Microsurgery for Recurrent Tumors After Radiation Therapy or Previous Surgical Resection

Abstract

Surgical outcome of recurrent vestibular schwannoma is more unsatisfactory than after primary surgery. It remains to be clarified whether previous surgery may implicate a higher risk for postoperative facial nerve function than previous radiation therapy upon surgery for tumor recurrence.

Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

“…Compared with observations reported in previous studies of repeat resection of VS tumors, 10,12,23 the findings in the present study suggest that our patients may have had an enhanced rate of preservation of facial nerve function. The authors of 1 study noted that facial nerve function deteriorated in 5 (42%) of 12 patients who underwent a repeat resection; 3 (30%) of 10 patients with preoperatively good facial function (i.e., of an HB grade of I-II) developed reduced or absent facial nerve function (of HB Grade ≥ III).…”

“…2,8,12,24,25 We note that during our 28-year experience of managing VSs with SRS, 18% of our patients previously underwent 1 or more microsurgical resections.…”

“…In none of these patients did hearing improve after SRS, an observation consistent with outcomes after repeat microsurgery. 12 At the time of undergoing SRS, 28% of the patients had tinnitus, and 35% of these patients reported that the tinnitus had resolved after SRS, whereas 4.8% developed new tinnitus.…”

“…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.…”

“…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.…”