Surgical management of vestibular schwannoma in elderly patients

Nuseir, Amjad; Sequino, Giulio; Donato, Giuseppe; Taibah, Abdelkader; Sanna, Mario

doi:10.1007/s00405-011-1566-2

Cited by 26 publications

(26 citation statements)

References 26 publications

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“…Minovi et al [18] also reported on one case (1.1%) of lethal PE after DVT in a series of 89 AN patients operated on via MFA. There is a comparable rate of PE in further series with mixed approaches of 0.2%-1.1% [14,[19][20][21][25][26][27] .…”

Section: Deep Venous Thrombosismentioning

confidence: 73%

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Scheich

Ginzkey²,

Müller³

et al. 2017

Int Adv Otol

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Section: Deep Venous Thrombosismentioning

confidence: 73%

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Scheich

Ginzkey²,

Müller³

et al. 2017

Int Adv Otol

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“…In elderly patients, despite the fact that complete removal is the main target of the surgery, adoption of NTR or STR in selected cases can decrease neurovascular injury, improve postoperative facial nerve results, and reduce the duration of surgery. 27 In case of a regrowth following such a scenario, SRS or Gamma Knife surgery (GKS) is preferable.…”

Section: Management Algorithmmentioning

confidence: 99%

The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas

Chen

Prasad²,

Lella³

et al. 2014

JNS

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Object The authors evaluated the behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas (VSs). Methods The case records of all patients who underwent surgical treatment of VSs were analyzed. All patients in whom an incomplete excision had been performed were analyzed. Incomplete excision was defined as near-total resection (NTR), subtotal resection (STR), and partial resection (PR). Tumors in the NTR and STR categories were followed up with a wait-and-rescan approach, whereas the tumors in the PR category were subjected to a second-stage surgery and were excluded from this series. All patients included in the study underwent baseline MRI at the 3rd and 12th postoperative months, and repeat imaging was subsequently performed every year for 7–10 years postoperatively or as indicated clinically. Preoperative and postoperative facial function was noted. Results Of the 2368 patients who underwent surgery for VS, 111 patients who had incomplete excisions of VSs were included in the study. Of these patients, 73 (65.77%) had undergone NTR and 38 (34.23%) had undergone STR. Of the VSs, 62 (55.86%) were cystic and 44 (70.97%) of these cystic VSs underwent NTR. The residual tumor was left behind on the facial nerve alone in 62 patients (55.86%), on the facial nerve and vessels in 2 patients (1.80%), on the facial nerve and brainstem in 15 patients (13.51%), and on the brainstem alone in 25 patients (22.52%). In the 105 patients with normal preoperative facial nerve function, postoperative facial nerve function was House-Brackmann (HB) Grades I and II in 51 patients (48.57%), HB Grade III in 34 patients (32.38%), and HB Grades IV–VI in 20 patients (19.05%). Seven patients (6.3%) showed evidence of tumor regrowth on follow-up MRI. All 7 patients (100%) who showed evidence of tumor regrowth had undergone STR. No patient in the NTR group exhibited regrowth. The Kaplan-Meier plot demonstrated a 5-year tumor regrowth-free survival of 92%, with a mean disease-free interval of 140 months (95% CI 127–151 months). The follow-up period ranged from 12 to 156 months (mean 45.4 months). Conclusions The authors' report and review of the literature show that there is undoubtedly merit for NTR and STR for preservation of the facial nerve. On the basis of this they propose an algorithm for the management of incomplete VS excisions. Patients who undergo incomplete excisions must be subjected to follow-up MRI for a period of at least 7–10 years. When compared with STR, NTR via an enlarged translabyrinthine approach has shown to have a lower rate of regrowth of residual tumor, while having almost the same result in terms of facial nerve function.

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“…Although several studies have evaluated surgical and observational outcomes in the elderly, few have directly compared microsurgical outcomes between elderly and nonelderly groups. 7,8 Our primary goals were to compare the risks of microsurgical resection in patient groups stratified by age and to test the hypothesis that symptomatic tumors in elderly patients represent a variant of VS that is more aggressive in these patients than in younger adults, resulting in increased morbidity and a higher rate of recurrence after STR.…”

mentioning

confidence: 99%

Vestibular schwannoma surgery in the elderly: a matched cohort study

Abel¹,

Carlson²,

Driscoll

et al. 2014

JNS

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As the number of elderly patients with VS increases, microsurgical resection will remain an important management option for these patients. Despite a poorer preoperative physical status in elderly patients, their morbidity profiles are similar to those in adult patients younger than 70 years. However, elderly patients may require longer convalescence due to prolonged postoperative imbalance. Not surprisingly, overall diminished functional reserve and advanced comorbidities may increase the mortality risk associated with surgical intervention in the elderly patients. Finally, there was a high risk of further tumor growth following STR in the elderly patients (6 [37.5%] of 16), underscoring the need for close postoperative radiological surveillance and consideration of early stereotactic radiosurgery for the tumor remnant following the STR.

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Surgical management of vestibular schwannoma in elderly patients

Cited by 26 publications

References 26 publications

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas

Vestibular schwannoma surgery in the elderly: a matched cohort study

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