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Outcomes of large vestibular schwannomas following subtotal resection: early post-operative volume regression and facial nerve function

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Abstract

Introduction

Subtotal resection (STR) of vestibular schwannoma (VS) tumors remains controversial and little is known regarding post-operative volume changes.

Methods

Authors retrospective reviewed the medical records from January 1st 2002 to January 1st 2018, for all patients who had undergone primary STR of large VS at a single tertiary academic institution.

Results

Our series consists of 34 patients with a mean age of 53.9 (median 53; range 21–87) years that had STR of their VS tumor. The mean pre-operative tumor diameter and volume was 3.9 cm (median 3.0 cm; range 1.6–6.0 cm) and 11.7 cm3 (median 9.6 cm3; range 2.8–44.3 cm3), respectively, with a mean extent of resection of 86% (median 90%; range 53–99%). The mean radiographic and clinical follow-up was 40 months (range 6–120 months) and 51 months (range 7–141 months), respectively. 85% of patients had optimal House–Brackmann (HB) scores (Grade 1 & 2) immediately post-operatively, and 91% at 1 year; 94% of patients had normal (HB 1) at last follow-up. There was significant regression of residual tumor volume at 1 year (p = 0.006) and 2 years (p = 0.02), but not at 3 years (p = 0.08), when compared to the prior year. There was significant regression of size over time, with a mean slope estimate of − 0.70 units per year (p < 0.001).

Conclusion

Excellent clinical facial nerve outcomes can be obtained with STR of large VS tumors. Maximal reduction in tumor size occurs at 2-year post-operatively. Thus, in patients undergoing surgery for large VS, STR and a “watch and wait” strategy is a reasonable treatment option that may optimize facial nerve outcomes.

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Abbreviations

HB:

House–Brackmann

MRI:

Magnetic resonance imaging

VS:

Vestibular schwannoma

SRS:

Stereotactic radiosurgery

STR:

Subtotal resection

References

  1. Cushing H (1917) Tumors of the nervus acusticus and the syndrome of the cerebellopontine angle. Saunders, Philadelphia

    Google Scholar 

  2. Dandy WE (1941) Results of removal of acoustic tumors by the unilateral approach. AMA Arch Surg 42:1026–1033

    Article  Google Scholar 

  3. Briggs RJ, Luxford WM, Atkins JS, Hitselberger WE (1994) Translabyrinthine removal of large acoustic neuromas. Neurosurgery 34:785–790 (discussion 790–781)

    CAS  PubMed  Google Scholar 

  4. Jung S, Kang SS, Kim TS, Kim HJ, Jeong SK, Kim SC et al (2000) Current surgical results of retrosigmoid approach in extralarge vestibular schwannomas. Surg Neurol 53:370–377 (discussion 377–378)

    Article  CAS  PubMed  Google Scholar 

  5. Lanman TH, Brackmann DE, Hitselberger WE, Subin B (1999) Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. J Neurosurg 90:617–623

    Article  CAS  PubMed  Google Scholar 

  6. Zhang X, Fei Z, Chen YJ, Fu LA, Zhang JN, Liu WP et al (2005) Facial nerve function after excision of large acoustic neuromas via the suboccipital retrosigmoid approach. J Clin Neurosci 12:405–408

    Article  PubMed  Google Scholar 

  7. Fuentes S, Arkha Y, Pech-Gourg G, Grisoli F, Dufour H, Regis J (2008) Management of large vestibular schwannomas by combined surgical resection and gamma knife radiosurgery. Prog Neurol Surg 21:79–82

    Article  PubMed  Google Scholar 

  8. Iwai Y, Yamanaka K, Ishiguro T (2003) Surgery combined with radiosurgery of large acoustic neuromas. Surg Neurol 59:283–289 (discussion 289–291)

    Article  PubMed  Google Scholar 

  9. Park CK, Jung HW, Kim JE, Son YJ, Paek SH, Kim DG (2006) Therapeutic strategy for large vestibular schwannomas. J Neurooncol 77:167–171

    Article  PubMed  Google Scholar 

  10. Starnoni D, Daniel RT, Tuleasca C, George M, Levivier M, Messerer M (2018) Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach. Neurosurg Focus 44:E4

    Article  PubMed  Google Scholar 

  11. Yang SY, Kim DG, Chung HT, Park SH, Paek SH, Jung HW (2008) Evaluation of tumour response after gamma knife radiosurgery for residual vestibular schwannomas based on MRI morphological features. J Neurol Neurosurg Psychiatry 79:431–436

    Article  PubMed  Google Scholar 

  12. Zumofen DW, Guffi T, Epple C, Westermann B, Krahenbuhl AK, Zabka S et al (2018) Intended near-total removal of Koos grade IV vestibular schwannomas: reconsidering the treatment paradigm. Neurosurgery 82:202–210

    Article  PubMed  Google Scholar 

  13. Chihara Y, Ito K, Sugasawa K, Shin M (2007) Neurological complications after acoustic neurinoma radiosurgery: revised risk factors based on long-term follow-up. Acta Otolaryngol 127(Suppl):65–70

    Article  Google Scholar 

  14. Flickinger JC, Kondziolka D, Niranjan A, Maitz A, Voynov G, Lunsford LD (2004) Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 60:225–230

    Article  PubMed  Google Scholar 

  15. Ito K, Shin M, Matsuzaki M, Sugasawa K, Sasaki T (2000) Risk factors for neurological complications after acoustic neurinoma radiosurgery: refinement from further experiences. Int J Radiat Oncol Biol Phys 48:75–80

    Article  CAS  PubMed  Google Scholar 

  16. van de Langenberg R, Hanssens PE, van Overbeeke JJ, Verheul JB, Nelemans PJ, de Bondt BJ et al (2011) Management of large vestibular schwannoma. Part I. Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects. J Neurosurg 115:875–884

    Article  PubMed  Google Scholar 

  17. Bakkouri WE, Kania RE, Guichard JP, Lot G, Herman P, Huy PT (2009) Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg 110:662–669

    Article  PubMed  Google Scholar 

  18. Breivik CN, Varughese JK, Wentzel-Larsen T, Vassbotn F, Lund-Johansen M (2012) Conservative management of vestibular schwannoma—a prospective cohort study: treatment, symptoms, and quality of life. Neurosurgery 70:1072–1080 (discussion 1080)

    Article  PubMed  Google Scholar 

  19. Deen HG, Ebersold MJ, Harner SG, Beatty CW, Marion MS, Wharen RE et al (1996) Conservative management of acoustic neuroma: an outcome study. Neurosurgery 39:260–264 (discussion 264–266)

    Article  CAS  PubMed  Google Scholar 

  20. Godefroy WP, Kaptein AA, Vogel JJ, van der Mey AG (2009) Conservative treatment of vestibular schwannoma: a follow-up study on clinical and quality-of-life outcome. Otol Neurotol 30:968–974

    Article  PubMed  Google Scholar 

  21. Kirchmann M, Karnov K, Hansen S, Dethloff T, Stangerup SE, Caye-Thomasen P (2017) Ten-year follow-up on tumor growth and hearing in patients observed with an intracanalicular vestibular schwannoma. Neurosurgery 80:49–56

    PubMed  Google Scholar 

  22. Merkus P, Sanna M (2010) Conservative or surgical treatment of a vestibular schwannoma. Otol Neurotol 31:548

    Article  PubMed  Google Scholar 

  23. Harris GJ, Plotkin SR, Maccollin M, Bhat S, Urban T, Lev MH et al (2008) Three-dimensional volumetrics for tracking vestibular schwannoma growth in neurofibromatosis type II. Neurosurgery 62:1314–1319 (discussion 1319–1320)

    Article  PubMed  Google Scholar 

  24. Vakilian S, Souhami L, Melancon D, Zeitouni A (2012) Volumetric measurement of vestibular schwannoma tumour growth following partial resection: predictors for recurrence. J Neurol Surg B Skull Base 73:117–120

    Article  PubMed  PubMed Central  Google Scholar 

  25. Walz PC, Bush ML, Robinett Z, Kirsch CF, Welling DB (2012) Three-dimensional segmented volumetric analysis of sporadic vestibular schwannomas: comparison of segmented and linear measurements. Otolaryngol Head Neck Surg 147:737–743

    Article  PubMed  Google Scholar 

  26. Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506–512

    Article  CAS  PubMed  Google Scholar 

  27. American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC (1995) Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otolaryngol Head Neck Surg 113:179–180

    Article  Google Scholar 

  28. Martin TP, Fox H, Ho EC, Holder R, Walsh R, Irving RM (2012) Facial nerve outcomes in functional vestibular schwannoma surgery: less than total tumour excision significantly improves results. J Laryngol Otol 126:120–124

    Article  CAS  PubMed  Google Scholar 

  29. Nakatomi H, Jacob JT, Carlson ML, Tanaka S, Tanaka M, Saito N et al (2017) Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma. J Neurosurg 1:1–7

    Article  Google Scholar 

  30. Cross T, Sheard CE, Garrud P, Nikolopoulos TP, O’Donoghue GM (2000) Impact of facial paralysis on patients with acoustic neuroma. Laryngoscope 110:1539–1542

    Article  CAS  PubMed  Google Scholar 

  31. Kiese-Himmel C, Laskawi R, Wrede S (1993) Psychosocial problems and coping with illness by patients with defective healing after facial paralysis. HNO 41:261–267

    CAS  PubMed  Google Scholar 

  32. Korb S, Wood A, Banks CA, Agoulnik D, Hadlock TA, Niedenthal PM (2016) Asymmetry of facial mimicry and emotion perception in patients with unilateral facial paralysis. JAMA Facial Plast Surg 18:222–227

    Article  PubMed  Google Scholar 

  33. Nellis JC, Ishii M, Byrne PJ, Boahene KDO, Dey JK, Ishii LE (2017) Association among facial paralysis, depression, and quality of life in facial plastic surgery patients. JAMA Facial Plast Surg 19:190–196

    Article  PubMed  PubMed Central  Google Scholar 

  34. VanSwearingen JM, Cohn JF, Turnbull J, Mrzai T, Johnson P (1998) Psychological distress: linking impairment with disability in facial neuromotor disorders. Otolaryngol Head Neck Surg 118:790–796

    Article  CAS  PubMed  Google Scholar 

  35. Hughes M, Skilbeck C, Saeed S, Bradford R (2011) Expectant management of vestibular schwannoma: a retrospective multivariate analysis of tumor growth and outcome. Skull Base 21:295–302

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tang S, Griffin AS, Waksal JA, Phillips CD, Johnson CE, Comunale JP et al (2014) Surveillance after resection of vestibular schwannoma: measurement techniques and predictors of growth. Otol Neurotol 35:1271–1276

    PubMed  Google Scholar 

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Acknowledgements

We thank David Hodge of the Mayo Clinic Florida statistics department for his assistance with analyzing this data.

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Authors and Affiliations

  1. Department of Neurologic Surgery, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Oluwaseun O. Akinduro, Alfredo Quinones-Hinojosa & Robert E. Wharen

  2. Department of Otolaryngology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Larry B. Lundy

  3. Department of Neuroradiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Vivek Gupta

  4. Department of Radiation Oncology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Daniel M. Trifiletti

  5. Department Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

    Victor M. Lu

Authors
  1. Oluwaseun O. Akinduro
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  3. Alfredo Quinones-Hinojosa
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  4. Victor M. Lu
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Correspondence to Robert E. Wharen.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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This study was approved by our institutional review board as minimal risk, thus negating need for written consent from each patient.

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Akinduro, O.O., Lundy, L.B., Quinones-Hinojosa, A. et al. Outcomes of large vestibular schwannomas following subtotal resection: early post-operative volume regression and facial nerve function. J Neurooncol 143, 281–288 (2019). https://doi.org/10.1007/s11060-019-03157-4

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  • DOI: https://doi.org/10.1007/s11060-019-03157-4

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