Surgical Outcomes in Cystic Vestibular Schwannoma Versus Solid Vestibular Schwannoma

Tang, Ing Ping; Freeman, Simon; Rutherford, Scott A.; King, Andrew T.; Ramsden, R. T.; Lloyd, Simon

doi:10.1097/mao.0000000000000435

Cited by 28 publications

(24 citation statements)

References 19 publications

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“…Numerous studies have reported worse outcomes with cystic tumors compared with solid tumors and recommend STR when GTR is not feasible. [30][31][32][33][34][35][36][37] Also, this study did not consider intracanalicular extension nor bony changes to the IAC as they have been reported to be insignificant factors for predicting FN outcome. 13,14,17,38 Additionally, increased overall tumor volume has also been linked to worse FN outcomes, as one would expect, but it is still uncertain whether tumor volume is more predictive than maximum tumor diameter.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas

et al. 2017

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This study analyzes the simple ratio of anterior-to-posterior extension of large (>2.5 cm) acoustic neuromas relative to the internal auditory canal (ICA; anterior-posterior [A/P] index) as a tool for predicting risk of facial nerve (FN) injury. In total, 105 patients who underwent microsurgical resection for large acoustic neuromas were analyzed retrospectively. House-Brackmann (HB) scores were assessed immediately postoperatively, at 1 month, and at 1 year. Lateral-medial, inferior-superior, A/P, and maximum diameters were measured from preoperative magnetic resonance images. These measurements and the A/P index were analyzed using univariable and multivariable statistical models to assess relationship to FN outcomes. The retrosigmoid, translabyrinthine, and combined approaches were used, and the extent of resection was evaluated. For every 1 standard deviation increase in the A/P index, a patient was 3.87 times more likely have a higher postoperative HB score ( < 0.0001). Accordingly, for every 1-mm increase anterior to the IAC, a patient was 16% more likely have a higher postoperative HB score ( < 0.001). After controlling for tumor size, a patient was still 3.82 times more likely have a higher postoperative HB score for every 1 standard deviation increase in the A/P index ( < 0.0001). While larger tumor size trended toward worse postoperative HB scores, it was not statistically significant. Our prognostic index may be useful to assess the risk of FN injury preoperatively for large acoustic neuromas, while also providing information about the tumor-nerve relationship.

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Section: Discussionmentioning

confidence: 99%

Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas

et al. 2017

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“…Cystic vestibular schwannnoma (CVS) should be distinguish from solid vestibular schwannoma (SVS) because of the their variant clinical, radiological, histopathological features and surgical outcomes. 2 , 3 , 4 , 5 CVS can be peripherally located thin-walled tumors, and centrally located thick-walled tumors based on CT or MRI images. CVS frequently presents rapid progression of symptoms with facial nerve involvement.…”

Section: Nomenclaturementioning

confidence: 99%

Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas

Zhang

Han³

et al. 2016

World j. otorhinolaryngol.-head neck surg.

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Sporadic vestibular schwannoma (acoustic neuroma) is a benign tumor arising from cochleovestibular nerve. Nowadays, various specialties and medical centers are treating this disease, and the multidisciplinary collaboration is the trend. In an effort to promote a uniform standard for reporting clinical results, even for treatment indications, the mainly controversies were posed and discussed during the 7th International Conference on acoustic neuroma, and the agreement was summarized by the Committee of this conference. The main symptoms grading and tumor stage should note its name of classification for making them comparable. The goal of the modern managements for vestibular schwannoma is to improve the quality of life with lower mortality, lower morbidity and better neurological function preservation. The experience of surgical team and their preference might be a major factor for the outcome. Because of lacking of long-term follow-up large data after radiotherapy, and with the development of microsurgery, radiotherapy is now less recommended except for recurrent cases or elderly patients.

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“…Some authors reported its association with worse outcomes, 10 whereas others showed no difference between cystic and solid tumors when considering facial nerve outcomes after surgery. 11 Tumor adhesion is also reported to be a factor influencing facial nerve outcomes. 9,12 In this context, we conducted a retrospective study of patients who were operated for total resection of vestibular schwannoma with anatomic preservation of the facial nerve.…”

mentioning

confidence: 99%

Multivariate Analysis of Factors Influencing Facial Nerve Outcome following Microsurgical Resection of Vestibular Schwannoma

Torres

Nguyen

Vanier

et al. 2016

Otolaryngol.--head neck surg.

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Objective To assess through multivariate analysis the clinical pre- and intraoperative factors of facial nerve outcomes at day 8 and 1-year recovery of facial palsy, as compared with day 8 status among patients who underwent total resection of unilateral vestibular schwannoma. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods This study included 229 patients with preoperative normal facial function and anatomic preservation of the facial nerve. Clinical, radiologic, and intraoperative factors were assessed according to facial nerve function at day 8 and 1 year. Results We observed that 74% and 84% of patients had good facial function (House-Brackmann [HB] I-II) at day 8 and 1 year, respectively. Of 60 patients, 26 (43%) who had impaired facial function (HB III-VI) at day 8 recovered good facial function (HB I-II) 1 year after surgery. A structured equation model showed that advanced tumor stage and strong facial nerve adhesion were independently associated with facial nerve conduction block at day 8. No predictive factor of impaired facial function recovery was seen at 1 year. In terms of the extracanalicular diameter of the tumor, the cutoff point to minimize the risk of impaired facial function was 16 mm. Conclusion At day 8 after vestibular schwannoma resection, facial function was impaired in the case of large tumors or strong facial nerve adhesion to the tumor. After 1 year, less than half of the patients recovered good facial function, and no predictive factor was found to be associated with this possible recovery.

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Surgical Outcomes in Cystic Vestibular Schwannoma Versus Solid Vestibular Schwannoma

Abstract: The difference in surgical outcomes is minimal between patients with CVS and those with SVS, not reaching statistical significance. We think, with judicious surgical management, similar outcomes can be achieved in cystic tumors and solid tumors.

Cited by 28 publications

References 19 publications

Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas

Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas

Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas

Multivariate Analysis of Factors Influencing Facial Nerve Outcome following Microsurgical Resection of Vestibular Schwannoma

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