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Refining the predictive value of preoperative apparent diffusion coefficient (ADC) by whole-tumor analysis for facial nerve outcomes in vestibular schwannomas

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Abstract

Background

Apparent diffusion coefficient (ADC) in MRI has been shown to correlate with postoperative House-Brackmann (HB) scores in patients with vestibular schwannoma despite limited methodology. To rectify limitations of single region of interest (ROI) sampling, we hypothesize that whole-tumor ADC histogram analysis will refine the predictive value of this preoperative biomarker related to postoperative facial nerve function.

Methods

Of 155 patients who underwent resection of vestibular schwannoma (2014–2020), 125 patients were included with requisite clinical and radiographic data. After volumetric analysis and whole-tumor ADC histogram, regression tree analysis identified ADC cutoff for significant differences in HB grade. Outcomes were extent of resection, facial nerve function, hospital length of stay (LOS), and complications.

Results

Regression tree analysis defined three quantitative ADC groups (× 10−6 mm2/s) as high (> 2248.77; HB 1.7), mid (1468.44–2248.77; HB 3.1), and low (< 1468.44; HB 2.3) range (p 0.04). The mid-range ADC group had significantly worse postoperative HB scores and longer hospital LOS. Large tumor volume was independently predictive of lower rates of gross total resection (p <0.0001), higher postoperative HB score (p 0.002), higher rate of complications (p 0.04), and longer LOS (p 0.003).

Conclusions

Whole-tumor histogram yielded a robust regression tree analysis that defined three ADC groups with significantly different facial nerve outcomes. This likely reflects tumor heterogeneity better than solid-tumor ROI sampling. Whole-tumor ADC warrants further study as a useful radiographic biomarker in patients with vestibular schwannoma who are considering surgical resection.

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Data availability

The datasets analyzed during the current study available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

ADC:

Apparent diffusion coefficient

CN:

Cranial nerve

DWI:

Diffusion-weighted imaging

GTR:

Gross total resection

HB:

House-Brackmann

MCP:

Middle cerebellar peduncle

MRI:

Magnetic resonance imaging

NTR:

Near total resection

STR:

Subtotal resection

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Acknowledgements

Our gratitude is present to Mary Kemper, who served as a medical editor for this original research.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Lindsey M. Freeman, Timothy H. Ung, John A. Thompson, Lisa Hirt, Patrick Hosokawa & A. Samy Youssef

  2. Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Olivia Ovard

  3. University of Colorado School of Medicine, Aurora, CO, USA

    Madeline Olson

  4. Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Ashesh Thaker

  5. Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    A. Samy Youssef

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Correspondence to A. Samy Youssef.

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Portions of this study were presented at the Conference on Vestibular Schwannoma and Other CPA Tumors on May 16, 2023 at Bergen, Norway.

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Freeman, L.M., Ung, T.H., Thompson, J.A. et al. Refining the predictive value of preoperative apparent diffusion coefficient (ADC) by whole-tumor analysis for facial nerve outcomes in vestibular schwannomas. Acta Neurochir 166, 168 (2024). https://doi.org/10.1007/s00701-024-06059-1

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