Evolving Role of Non-Total Resection in Management of Acoustic Neuroma in the Gamma Knife Era. Issue 10 (December 2020)

• Record Type: Journal Article
• Authors: Luryi, Alexander L.; Kveton, John F.; Babu, Seilesh; Bojrab, Dennis I.; Michaelides, Elias M.; Schutt, Christopher A.
• Is Part Of: Otology & neurotology. Volume 41:Issue 10(2020)
• Publication Date: 2020-12
• Subjects: Near-total -- Outcomes -- Stereotactic radiosurgery -- Subtotal -- Vestibular schwannoma; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000002904
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: To examine patients with residual tumor after vestibular schwannoma (VS) resection with focus on need for further therapy, including stereotactic radiosurgery (SRS) and revision surgery. Study Design and Setting: Retrospective review at two tertiary otology referral centers. Patients and Intervention: Patients undergoing primary surgery for VS from 2007 to 2017. Main Outcome Measure: Degree of resection and need for further treatment. Results: Of 289 patients undergoing surgery, 38 (13.1%) underwent subtotal resections (<95% of tumor resected) and 77 (26.6%) underwent near-total resections (≥95% but <100%). Patients with any residual tumor had larger tumors preoperatively (mean estimated volume 6.3 cm 3 versus 2.1 cm 3, p < 0.0005) but were otherwise clinically and demographically similar to the population as a whole. Further treatment (surgery or SRS) was needed in 4.6, 14.3, and 50.0% of patients after gross total, near-total, and subtotal resections, respectively ( p < 0.0005). Patients undergoing additional therapy had larger residual tumors (median post- to preoperative estimated volume ratio 0.09 versus 0.01, p < 0.0005). Patients undergoing subtotal and near-total resections had poorer facial function at ultimate follow up than those undergoing gross total resections ( p = 0.001), likely due to larger tumors and more difficult resections. Literature review revealed higher rates of gross total resection as well as facial palsy in the pre-SRS era. Conclusion: Residual tumor following VS resection is more common today than in the pre-SRS era. Availability of SRS may encourage leaving residual tumor intraoperatively to preserve neural structures. Current surgical strategies decrease surgical morbidity but necessitate further treatment in over 10% of cases.