Clinical Outcomes of Salvage Microsurgical Resection after Radiation Therapy for Sporadic Vestibular Schwannomas

Abstract

Background: The purpose of this study was to evaluate clinical outcomes after salvage microsurgery for VS treated initially with modern radiotherapy techniques as compared to those treated with primary microsurgical resection. Methods: Patients who underwent microsurgical resection of sporadic VS undergoing a translabyrinthine approach at a single academic skull base tertiary referral center were included. Baseline and post-operative dynamic gait index (DGI), functional gait assessment (FGA), House-Brackman facial nerve grading, and completeness of resection were prospectively recorded. Results: Of the 265 patients reviewed, 21 (7.9%) patients underwent prior radiation. Median age of the cohort was 55 years (IQR 51, 63). The likelihood of achieving a gross total resection was significantly lower for radiated as compared to non-radiated patients (Odds ratio [OR] 0.18, 95% CI 0.05 – 0.53, p = 0.004) when controlling for tumor size. Radiated patients had better postoperative facial nerve function on the first postoperative day, but this difference was not significant at long term follow up. Radiated patients had lower preoperative postural stability scores than non-radiated patients on FGA (26 vs. 23, p=0.035). Post-operatively, radiated patients had comparable outcomes compared to non-radiated patients when controlling for age and tumor size. Conclusions: Compared to patients with VS treated with surgery alone, previously radiated patients are less likely to achieve gross total resection in the salvage setting. Radiated patients scored better on facial nerve outcomes compared to non-radiated patients in the initial post-operative period but demonstrated similar long-term outcomes.