Microsurgical Removal of Vestibular Schwannomas after Failed Previous Microsurgery

Roche, Pièrre-Hugues; Khalil, Muhamad; Thomassin, J M

doi:10.1159/000156903

Cited by 21 publications

(15 citation statements)

References 3 publications

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“…The median period between initial microsurgical resection and surgery for recurrence in our series was 79 months. This time interval is comparable to previous reports (6,13,28). Most articles on repeated surgical treatment have focused mainly on small or middle-sized tumors, whereas there are less data on large recurrent tumors.…”

Section: Surgical Resection After Previoussupporting

confidence: 87%

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

Hong

Krauss²,

Bremer³

et al. 2014

Otology &Amp; Neurotology

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Section: Surgical Resection After Previoussupporting

confidence: 87%

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

Hong

Krauss²,

Bremer³

et al. 2014

Otology &Amp; Neurotology

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“…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).…”

Section: Neurological Outcomescontrasting

confidence: 50%

“…23 The largest study to date reported that 16 (46%) of 35 patients had worsening facial function 1 year after repeat surgery (1 patient's facial function was already HB Grade VI). Twelve (57%) of 21 patients with HB Grade I-II facial function at the time of revision surgery had deterioration of facial function.…”

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confidence: 99%

Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

Huang

Kano

Mousavi

et al. 2017

Journal of Neurosurgery

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V estibular schwannomas (VSs), also known as acoustic neuromas, are benign primary intracranial tumors that arise from the Schwann cells of the vestibulocochlear nerve. The incidence of VS is estimated to be 1 per 100,000 individuals per year, and it accounts for approximately 8% of all intracranial tumors in adults. 3,14 These tumors are typically slow growing (0-3.9 mm per year), but without management, most VS tumors will grow within 3 years. 4,6,14,15,18,20 For many years, microsurgical resection remained the most commonly recommended treatment for patients with newly diagnosed unilateral VS. 3,20 Although surgical outcomes have improved over the last 30 years, resection of VS was frequently associated with impaired facial nerve function and loss of hearing. 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. METHODS From the authors' database of 1770 patients with VS, the authors retrospectively analyzed data from 173 Gamma Knife SRS procedures for VS after 1 (128 procedures) or multiple (45 procedures) microsurgical resections. The median length of the interval between the last resection and SRS was 42 months (range 2-329 months). The median length of clinical follow-up was 74 months (range 6-285 months). Progression-free survival after SRS was determined with Kaplan-Meier analysis. RESULTS At the time of SRS, the hearing of 161 patients (93%) was Gardner-Robertson Class V, and 81 patients (47%) had facial neuropathy (i.e., facial function with House-Brackmann [HB] grades of III-VI), 87 (50%) had trigeminal neuropathy, and 71 (41%) reported imbalance or disequilibrium disorders. The median tumor volume was 2.7 cm 3 (range 0.2-21.6 cm 3 ), and the median dose to the tumor margin was 13 Gy (range 11-20 Gy). Radiosurgery controlled growth of 163 (94%) tumors. Progression-free survival after SRS was 97% at 3 years, 95% at 5 years, and 90% at 10 years. Four patients with delayed tumor progression underwent repeat SRS at a median of 35 months (range 23-64 months) after the first SRS. Four patients (2.3%) w...

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“…3 Repeat operation is also associated with an increased risk of complications, including poor facial nerve outcome-only 50% of patients preserve their good facial nerve function. 3,13 In cases in which GKS fails and microsurgical resection is required, facial nerve preservation is 52%, a significant drop from the expected chance of facial nerve preservation with either treatment alone. 14 Patients in whom initial treatment (either radiosurgery or microsurgery) failed, who are re-treated with radiosurgery for their residual tumor, have had better outcomes; 90% of patients with good facial nerve function prior to radiosurgery had preservation of their facial function.…”

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confidence: 99%

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

Haque

Wojtasiewicz²,

Gigante³

et al. 2011

JNS

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Object. The goal of this article was to show that a combination of facial nerve-sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS).Methods. Records of individuals treated by a single surgeon with a facial nerve-sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.2%) of these patients required postoperative retreatment for a significant expansion of residual tumor after microsurgery. These 20 patients were re-treated with GKS.Results. The rate of preservation of good facial nerve function (Grade I or II on the House-Brackmann scale) in patients treated with microsurgery for VS was 97%. Both subtotal and gross-total resection had excellent facial nerve preservation rates (97% vs 96%), although subtotal resection carried a higher risk that patients would require retreatment. In patients re-treated with GKS after microsurgery, the rate of facial nerve preservation was 95%.Conclusions. In patients with tumors that cannot be managed with radiosurgery alone, a facial nerve-sparing resection followed by GKS for any significant regrowth provides excellent facial nerve preservation rates. (DOI: 10.3171/2011.7.JNS101921) key WoRDs • vestibular schwannoma • facial nerve • Gamma Knife surgery • tumor recurrence • peripheral nerve 917Abbreviations used in this paper: GKS = Gamma Knife surgery; GTR = gross-total resection; HB = House-Brackmann; IAC = internal auditory canal; NF2 = neurofibromatosis Type 2; STR = subtotal resection; VS = vestibular schwannoma.

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Microsurgical Removal of Vestibular Schwannomas after Failed Previous Microsurgery

Cited by 21 publications

References 3 publications

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

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

Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

Efficacy of facial nerve–sparing approach in patients with vestibular schwannomas

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