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Is salvage surgery for large vestibular schwannomas after failed gamma knife radiosurgery more challenging?

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Abstract

In order to verify whether a previous gamma knife surgery (GKS) treatment could influence the oncological and functional outcome in large vestibular schwannoma (VS) surgery, we have compared group of patients operated on for large VS after failed GKS to a group of genuine VS that underwent the same functional nerve-sparing resection technique regimen in the same period. Single center retrospective cohort study of 23 consecutive GKS failure and 170 genuine VS patients operated on between April 2003 and March 2019. After resection, patients were allocated to a Wait-&-rescan or an upfront GKS policy. At last follow-up examination, the facial nerve function was good (House-Brackmann grades I or II) in 95% of the GKS failure and 84% of the genuine VS patients (p = .25). The median volume of tumor residue was .56 cc in the GKS failure group and .62 cc in the genuine VS group (p = .70). Tumor control was achieved in 91% and 83% of cases with a mean follow-up of 74 and 63 months in the GKS failure and the genuine VS populations, respectively. The 1-, 5-, and 7-year progression-free survival were 100%, 95%, and 85% respectively in the GKS failure group and 97%, 80%, and 81% in the genuine VS group (p = .27). Despite significant modifications of the microsurgical environment associated to salvage surgery after GKS failure, a functional nerve-sparing resection is an effective strategy to optimize the results on facial nerve function, with similar long-term tumor control to those observed in the genuine VS population.

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Authors and Affiliations

  1. Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France

    Lucas Troude, Guillaume Baucher, Jean-Pierre Lavieille & Pierre-Hugues Roche

  2. Department of Statistical Analysis, Faculté Des Sciences Médicales Et Paramédicales, Aix-Marseille Université (AMU), 27 bd Jean Moulin, 13385, Marseille, France

    Mohamed Boucekine

  3. Department of Neurosurgery, Timone University Hospital, APHM-AMU, 264 Rue Saint-Pierre, 13385, Marseille, France

    Anne Balossier & Jean Régis

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  1. Lucas Troude
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Contributions

All authors have made substantial contributions so as to qualify for authorship and have read and approved the final version of this manuscript.

- LT, JPL, JR, PHR: conception and design of the study.

- LT, AB, GB: acquisition of data and drafting the article.

- LT, MB: analysis and interpretation of data.

- JPL, JR, PHR: critically revising the article.

Corresponding author

Correspondence to Lucas Troude.

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Aix-Marseille University Ethics Comittee (Authorization number: 2018–24-01–003).

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Troude, L., Boucekine, M., Balossier, A. et al. Is salvage surgery for large vestibular schwannomas after failed gamma knife radiosurgery more challenging?. Neurosurg Rev 45, 751–761 (2022). https://doi.org/10.1007/s10143-021-01604-3

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  • DOI: https://doi.org/10.1007/s10143-021-01604-3

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