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

Oluwaseun O. Akinduro, Larry B Lundy, Alfredo Quinones-Hinojosa, Victor M. Lu, Daniel Trifiletti, Vivek Gupta, Robert E. Wharen

Research output: Contribution to journalArticle

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 languageEnglish (US)
JournalJournal of neuro-oncology
DOIs
StatePublished - Jan 1 2019

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Acoustic Neuroma
Facial Nerve
Tumor Burden
Neoplasms
Residual Volume
Residual Neoplasm
Medical Records

Keywords

  • Acoustic neuroma
  • Stereotactic radiosurgery
  • Subtotal resection
  • Vestibular schwannoma
  • Volume reduction

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

@article{ab006388f1784cc1a33c581c00da992d,
title = "Outcomes of large vestibular schwannomas following subtotal resection: early post-operative volume regression and facial nerve function",
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.",
keywords = "Acoustic neuroma, Stereotactic radiosurgery, Subtotal resection, Vestibular schwannoma, Volume reduction",
author = "Akinduro, {Oluwaseun O.} and Lundy, {Larry B} and Alfredo Quinones-Hinojosa and Lu, {Victor M.} and Daniel Trifiletti and Vivek Gupta and Wharen, {Robert E.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11060-019-03157-4",
language = "English (US)",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Kluwer Academic Publishers",

}

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

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