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 cm 3 (median 9.6 cm 3 ; range 2.8–44.3 cm 3 ), 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.
| Original language | English (US) |
|---|---|
| Journal | Journal of neuro-oncology |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- Acoustic neuroma
- Stereotactic radiosurgery
- Subtotal resection
- Vestibular schwannoma
- Volume reduction
ASJC Scopus subject areas
- Oncology
- Neurology
- Clinical Neurology
- Cancer Research
Cite this
Outcomes of large vestibular schwannomas following subtotal resection : early post-operative volume regression and facial nerve function. / Akinduro, Oluwaseun O.; Lundy, Larry B; Quinones-Hinojosa, Alfredo; Lu, Victor M.; Trifiletti, Daniel; Gupta, Vivek; Wharen, Robert E.
In: Journal of neuro-oncology, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcomes of large vestibular schwannomas following subtotal resection
T2 - early post-operative volume regression and facial nerve function
AU - Akinduro, Oluwaseun O.
AU - Lundy, Larry B
AU - Quinones-Hinojosa, Alfredo
AU - Lu, Victor M.
AU - Trifiletti, Daniel
AU - Gupta, Vivek
AU - Wharen, Robert E.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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 cm 3 (median 9.6 cm 3 ; range 2.8–44.3 cm 3 ), 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.
AB - 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 cm 3 (median 9.6 cm 3 ; range 2.8–44.3 cm 3 ), 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.
KW - Acoustic neuroma
KW - Stereotactic radiosurgery
KW - Subtotal resection
KW - Vestibular schwannoma
KW - Volume reduction
UR - http://www.scopus.com/inward/record.url?scp=85064648663&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064648663&partnerID=8YFLogxK
U2 - 10.1007/s11060-019-03157-4
DO - 10.1007/s11060-019-03157-4
M3 - Article
C2 - 30989621
AN - SCOPUS:85064648663
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
SN - 0167-594X
ER -