Recurrence of Vestibular Schwannomas after Surgery

Abstract

The issue of recurrence of vestibular schwannomas is poorly studied by the surgical literature and is probably underestimated. Our own long-term retrospective analysis after translabyrinthine approach has indicated a 9.2% recurrence rate. This long-term event is mainly due to regrowth of microfragments that have been left in the operative field along the course of the facial nerve or at the surface of the pons. Management of recurrence depends on the tumor size and patient's condition. Our current policy is to propose a Gamma Knife radiosurgical treatment in eligible cases. Prospective long-term follow-up studies using serial MR imaging after radical removal should bring reliable data about the incidence of vestibular schwannoma recurrence.

Prediction of vestibular schwannoma recurrence using artificial neural network

“…We found that the VS recurrence rate in a large sample of ANA respondents was 14.5% and years since treatment and resection amount were the two independent predictors of recurrence. Various studies have reported a recurrence rate of 5% to 45% associated with different treatment modalities . The observed recurrence rate in this study is within the wide range of reported rates in the literature, which is likely due to its comprehensive patient‐centered and survey‐based nature.…”

Stereotactic radiosurgery for recurrent vestibular schwannoma after previous resection

“…2,8,12,24,25 We note that during our 28-year experience of managing VSs with SRS, 18% of our patients previously underwent 1 or more microsurgical resections.…”

“…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.…”

“…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.…”

Rare Instances of Long Term Recurrence in Two Cases of Vestibular Schwannoma After Total Tumor Removal (13 and 16 Years After Surgery)

“…After this timetumor recurrence was theoretically possible but extremely improbable.Like us, Carlson et al 10 also recommend a repeat imaging at 15 years for linear enhancement during follow-up. Barring Roche et al [12]who reported 9.2% recurrence rate after TLA for VSwith a followup ranging from 8 to 16 years there have been no reports of recurrences after 10 years of follow-up, nor have been authors advocating a follow-up for greater than 10 years. However, considering that the incidence of long-term recurrence (after 10 years) after GTR of VS is still very low (2/2553 cases; 0.08%) the cost-benefit ratio of following up all VS for five more years must also be considered.…”