Near total extirpation of vestibular schwannoma with salvage radiosurgery. (13th January 2015)

• Record Type: Journal Article
• Authors: Jeltema, Hanne Rinck; Bakker, Nicolaas A.; Bijl, Hendrik P.; Wagemakers, Michiel; Metzemaekers, Jan D. M.; van Dijk, J. Marc C.
• Is Part Of: Laryngoscope. Volume 125:Number 7(2015:Jul.)
• Page Start: 1703
• Page End: 1707
• Publication Date: 2015-01-13
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.25115
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary25115-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>The management of a sporadic vestibular schwannoma (VS) has changed with the introduction of stereotactic radiosurgery (SRS). Because functional outcome is important, particularly regarding the facial nerve, a policy of near‐total surgical resection of a large‐size VS has emerged, minimizing damage to the facial nerve. The debate remains whether the surgical remnant should be treated immediately or after established growth.</p> </sec> <sec id="lary25115-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective case series.</p> </sec> <sec id="lary25115-sec-0003" sec-type="section"> <title>Methods</title> <p>A consecutive cohort of 55 patients underwent a retrosigmoid craniotomy and near‐total removal of a large‐size VS at our university medical center between 2005 and 2011 and had a follow‐up of a least 3 years. Documented growth of the VS remnant after surgery necessitating adjuvant SRS was the primary outcome measure using analysis of variance.</p> </sec> <sec id="lary25115-sec-0004" sec-type="section"> <title>Results</title> <p>In 45 patients (81.8%), a small tumor remnant was left during surgery. The mean preoperative tumor volume was 12.2 cm<sup>3</sup> (range, 1.13–50.16 cm<sup>3</sup>); the mean volume of the remnant was 0.22 cm<sup>3</sup> (range, 0–1.52 cm<sup>3</sup>). The mean postoperative follow‐up time was 35.4 months (range, 3–76 months). Salvage SRS was deemed necessary in seven patients (13.0%). The size of the postoperative tumor remnant was a significant predictor for the necessity of postoperative adjuvant SRS. Normal facial nerve function (House‐Brackmann [HB] I) was preserved in 30 patients (57.7%), 17 patients (32.7%) experienced a permanent mild facial nerve deficit (HB II, III), and five patients (9.6%) experienced a severe facial nerve deficit (HB grade IV–VI).</p> </sec> <sec id="lary25115-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Initial observation after near total surgical removal of VS is a feasible strategy, with only a minority requiring salvage radiosurgery during follow‐up.</p> </sec> <sec id="lary25115-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4. <italic>Laryngoscope</italic>, 125:1703–1707, 2015</p> </sec> </abstract>