Anterior Extension of Tumor is as Important as Tumor Size to Facial Nerve Outcome and Extent of Resection for Vestibular Schwannomas

Wong, Ricky H.; Copeland, William R.; Jacob, Jeffrey T.; Sivakanthan, Sananthan; Gompel, Jamie J. Van; Loveren, Harry van; Link, Michael J.; Agazzi, Siviero

doi:10.1055/s-0037-1604331

Cited by 17 publications

(12 citation statements)

References 23 publications

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“…Additionally, in a retrospective study of 206 VS-66% underwent RS resection and 34% underwent TL resection, Wong et al found that anterior extension, specifically greater than 15 mm of anterior extension, was associated with worse outcomes. 20 No VS in our sample had greater than 15 mm of anterior extension, so potentially the present study had a disproportionate number of more posterior positioned tumors. However, unlike the current study, Sharma et al, and Gerganov et al studies, Wong et al measured anterior extension from a line that bisected the internal auditory canal rather than from the anterior border of the internal auditory canal, making comparison more challenging.…”

Section: Discussionmentioning

confidence: 80%

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

et al. 2020

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Objective: To explore the relationship between tumor size and facial nerve outcomes following vestibular schwannoma (VS) resection. Study Design: Single institutional retrospective chart review of all adult patients with untreated sporadic VS who underwent surgical resection from 2008 to 2018 with preoperative magnetic resonance imaging (MRI) and 1 year of follow-up. The primary outcome measure was facial nerve outcome as assessed by the House-Brackmann facial nerve grading system. Results: One hundred sixty-seven patients, 54.5% female, with a median age of 49 years (20-76 years), were identified who underwent VS resection. Surgical resection was performed by translabyrinthine (76.7%), middle cranial fossa (14.4%), retrosigmoid (7.2%), and transpromontorial (1.8%) approaches. The median tumor diameter and volume were 25.3 mm (range: 4.1-47.1 mm) and 3.17 cm 3 (range: 0.01-30.6 cm 3), respectively. The median follow-up was 24.2 months (range: 12-114.2 months). Gross total resection was performed in 79% of cases, with residual tumor identified on MRI in 17% of cases. For patients with tumors <3 cm 3 , 92.7% had grade 1 or 2 facial function after at least 1 year follow-up, compared to 81.2% for those with tumors >3 cm 3 (univariate logistic regression OR = 2.9, P = .03). Tumor volume >3 cm 3 was predictive of facial weakness on multivariate regression analysis (OR = 7.4, P = .02) when controlling for surgical approach, internal auditory canal extension, anterior extension, age, gender, and extent of resection. Conclusions: Tumor volume >3 cm 3 is associated with worse facial nerve outcomes 12 months following surgical resection.

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Section: Discussionmentioning

confidence: 80%

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

et al. 2020

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“…One risk is that of facial paralysis, a potentially devastating outcome that has been demonstrated to result in psychological distress 1 and decreased quality of life (QOL) 2 . The risk of facial paralysis following surgical resection has been correlated with previous radiation therapy, increasing tumor size, 3–6 tumor position, 7 and direction of tumor growth 7–10 . With increasing tumor size, the facial nerve can become displaced, compressed, splayed across, or adherent to the surface of the tumor.…”

Section: Introductionmentioning

confidence: 99%

Vestibular Schwannoma Cerebellopontine Angle Position Impacts Facial Outcome

et al. 2021

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Objectives/Hypothesis To determine the impact of vestibular schwannoma (VS) position relative to the internal auditory canal (IAC) on postoperative facial nerve function and extent of surgical resection. Study Design Retrospective chart review. Methods Retrospective review of patients undergoing resection of large (≥25 mm) VSs. Outcome measures included early (≤1 month) facial function, long‐term (≥1 year) facial function and extent of resection. Tumor measurements included the greatest dimension, dimension anterior to the IAC axis, dimension posterior to the IAC axis, and a ratio of posterior‐to‐anterior dimension (PA ratio). Results A total of 127 patients met inclusion criteria. In early follow‐up, 60% patients had good (House‐Brackmann I–II), and 40% patients had poor (House‐Brackmann III–VI) facial function. In long‐term follow‐up, 71% patients had good, and 29% patients had poor facial function. A total of 72% of patients underwent gross total resection (GTR) of their tumors. Patients with good facial function had significantly larger PA ratios than patients with poor function both early and long term; however, greatest dimension was the more clearly significant independent predictor of facial outcomes. A larger PA ratio was observed in patients in whom GTR was achieved, but this association was potentially confounded by surgeon preferences and was not statistically significant after controlling for surgical site. Conclusions This study demonstrates that VS position relative to the IAC axis can be used along with tumor size to predict postoperative facial outcomes. A greater proportion of tumor posterior to the IAC axis was associated with significantly better facial outcomes. Level of Evidence 4 Laryngoscope, 132:1093–1098, 2022

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“…[10] In addition, a number of studies have been conducted to determine the pre-surgical factors to predict facial nerve results in schwannoma surgery. Wong et al [27] reported that factors such as advanced patient age, large dimensions of tumor and position according to surrounding anatomical structures (adhesion, compression, wrapping of normal structures by tumor tissue, etc. ), cystic or solid tumor character, surgical access route and increasing extent of surgical resection are factors affecting the prognosis negatively.…”

Section: Discussionmentioning

confidence: 99%

“…Images should be well examined before surgery in order to reveal the facial nerve-tumor relationship, the stiffness of the tumor, and selection of optimal surgical approach. [27] The success of surgery depends on the complete removal of the tumor without additional neurological deficits. Samii and Matthies's [37,38] study of 1,000 cases achieved a total resection rate of 97.9%.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric vestibular schwannomas: Evaluation of clinical features, treatment strategies and long-term results of 10 cases

Başar¹

2018

Tr-ENT

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Objectives: This study aims to analyze and discuss the epidemiology, clinical-radiological features, differential diagnosis, histopathological characteristics, treatment strategies and long-term follow-up results of pediatric vestibular schwannomas (VSs) treated at a single institution. Patients and Methods: Medical records of 10 pediatric patients (3 males, 7 females; mean age 14.9±2.3 years; range 11 to 18 years) who were operated for VSs in our department between January 2000 and December 2017 were retrospectively reviewed. The prognostic variables were age, gender, neurological examination at the time of application, radiologic findings, localization, associated factors, amount of resection (total [100%], near total [90-100%] or subtotal [<90%] resection), histopathological grading and adjuvant treatment. Results: Two patients had neurofibromatosis type 2 (NF2), while others were sporadic cases. Mean age at diagnosis was 14.9±2.3 years. Major presenting symptoms and signs were hearing loss, tinnitus, headache, imbalance, hemiparesis and facial numbness. Patients had an average of 2.5±1.0 years of symptom duration. In eight of 10 patients, total or near-total tumor resection was achieved. Although the facial nerve was anatomically preserved in all patients, early facial dysfunction occurred in 60%. At the end of an average follow-up of 9.4±5.0 years, 80% of patients had normal or acceptable facial nerve function (House-Brackmann grade I or II), whereas two patients had permanent facial paralysis (House-Brackmann grade V or VI). Tumor progression and recurrence were observed in two patients. Conclusion: Pediatric VSs are rare tumors commonly associated with NF2. Expected long-term survival necessitates effective treatment. Microsurgery is a powerful strategy with possibility of total tumor removal and minimal morbidity rates. Radiosurgery can be used particularly in residual or recurrent tumors or those not exceeding 2-3 cm, although long-term results are not well known in children.

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Anterior Extension of Tumor is as Important as Tumor Size to Facial Nerve Outcome and Extent of Resection for Vestibular Schwannomas

Cited by 17 publications

References 23 publications

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

The Association of Vestibular Schwannoma Volume With Facial Nerve Outcomes After Surgical Resection

Vestibular Schwannoma Cerebellopontine Angle Position Impacts Facial Outcome

Pediatric vestibular schwannomas: Evaluation of clinical features, treatment strategies and long-term results of 10 cases

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