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“Large and giant vestibular schwannomas: overall outcomes and the factors influencing facial nerve function”

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Abstract

(1) To study the overall outcomes of patients surgically treated for large/giant vestibular schwannomas (VSs) and (2) to identify and analyze preoperative and intraoperative prognostic factors influencing facial nerve (FN) outcome. A retrospective clinical study was conducted at a quaternary referral otology and skull-base center. A total of 389 cases were enrolled. The inclusion criteria were patients with tumor > 30 mm undergoing surgery with a minimum follow-up of 12 months. Neurofibromatosis-II, previous radiotherapy, revision surgeries, preoperative FN House-Brackmann (HB) grade > I, partial resections, incomplete records, or those lost to follow-up for a minimum period of 1 year were excluded. In addition, partial resections and cases where FN was sacrificed intraoperatively were also excluded and were analyzed separately. The mean duration of symptoms was 35.4 months, pronounced more in elderly (58.3 months) than in younger individuals (28.4 months). Mean tumor diameter was 36 mm and 52.7% was cystic. Total resection (TR), near total resection (NTR), and subtotal resections (STR) were achieved in 77.4%, 9.5%, and 13.2% of cases, respectively. Regrowth was observed only after STR (19.6%). Good (HB I-II), moderate (HB III), and poor (HB IV-VI) FN functions were observed in 36.8%, 51.7%, and 11.6% cases, respectively. Younger individuals underwent TR in 259 (86.9%) cases against 42 (46.2%) in elderly individuals. Non-total resections (NTR/STR) were performed in 49 (53.8%) cases in elderly as against 39(13.1%) in younger individuals. Good FN outcome was observed in 28 (57.1%) cases of non-total resections in elderly as against 13 (33.3%) cases in younger individuals. On multiple logistic regression analysis, size of the tumor, preoperatively prolonged duration of symptoms, profound deafness, and antero-superiorly located FN with respect to the tumor played a detrimental role in the final facial nerve outcome postoperatively. On the contrary, in large tumors (3–3.9 cm), presence of vertigo/disequilibrium had a relatively better impact on final FN outcome. Partial resections accounted for 41(7.8%) cases and FN was interrupted in 71(13.6%) cases in total. Factors detrimental to better FN outcome were giant VSs (> 4 cm), antero-superiorly located FN intratumorally, preoperatively prolonged duration of symptoms, and profound deafness. In large tumors (3–3.9 cm), presence of vertigo/disequilibrium had a better impact on FN outcome. Understandably, cases with TR in comparison with NTR/STR had worse FN outcomes. In comparison with younger patients, elderly patients underwent higher NTR/STR resulting in better FN outcomes. The above factors can be used as prognosticators for patient counseling and surgical decision making.

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Acknowledgments

We thank the team of Mrs. Sathi Chakraborty, Director, Tagore Institute, Bengaluru, for agreeing to review the paper for English corrections. We also thank Dr. Shivalingappa Javali, Associate Professor, USM-KLE, International Medical College, Belgaum and Professor, Michael Hopp, Medical statistician, Tel Aviv University, Israel, for performing all the statistical work involved in the paper.

Funding

This study is funded by all the members of the Gruppo Otologico, Italy.

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Authors and Affiliations

  1. Department of Otology & Skull Base Surgery, Gruppo Otologico, Via Emmanueli, 42, 29121, Piacenza, Italy

    Golda Grinblat, Manjunath Dandinarasaiah, Abdelkader Taibah, Dario Giuseppe Lisma & Mario Sanna

  2. Department of ENT, Head and Neck Surgery, Hillel Yaffe Medical Center, Technion University, 169, 38100, Hadera, Israel

    Golda Grinblat & Itzak Braverman

  3. Department of ENT, Head and Neck surgery, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, 580021, India

    Manjunath Dandinarasaiah

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  1. Golda Grinblat
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Correspondence to Manjunath Dandinarasaiah.

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The Gruppo Otologico -Institutional Review Board (IRB) has given ethical clearance for this retrospective analysis (GO IRB- 182/2020).

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Grinblat, G., Dandinarasaiah, M., Braverman, I. et al. “Large and giant vestibular schwannomas: overall outcomes and the factors influencing facial nerve function”. Neurosurg Rev 44, 2119–2131 (2021). https://doi.org/10.1007/s10143-020-01380-6

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