Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas

Neil S. Patel, Kathryn M. Van Abel, Michael J. Link, Colin L W Driscoll, Jamie Van Gompel, Brian A. Neff, John I. Lane, Matthew L. Carlson

Research output: Contribution to journalArticle

Abstract

Objective Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome. Study Design Case series with chart review. Setting Academic referral center. Subjects and Methods A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed. Results Excluding strictly intracanalicular tumors (n = 32, 16%) and those with NF2 (n = 10, 4.9%), the presence of dural enhancement was radiographically confirmed in 16 (9.8%) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31%) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3%) of the matched controls (P =.01). Four (25%) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3%, P =.04). Long-term facial nerve function was similar between cases and controls (81% vs 84% House-Brackmann I-II function, P = 1.00). Conclusion Dural enhancement is present in approximately 10% of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.

Original languageEnglish (US)
Pages (from-to)1021-1027
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume155
Issue number6
DOIs
StatePublished - Dec 1 2016

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Acoustic Neuroma
Facial Nerve
Neoplasms
Counseling
Referral and Consultation
Magnetic Resonance Imaging

Keywords

  • acoustic neuroma
  • cranial base
  • meningioma
  • neurotology
  • skull base
  • vestibular schwannoma

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas. / Patel, Neil S.; Van Abel, Kathryn M.; Link, Michael J.; Driscoll, Colin L W; Van Gompel, Jamie; Neff, Brian A.; Lane, John I.; Carlson, Matthew L.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 155, No. 6, 01.12.2016, p. 1021-1027.

Research output: Contribution to journalArticle

Patel, Neil S. ; Van Abel, Kathryn M. ; Link, Michael J. ; Driscoll, Colin L W ; Van Gompel, Jamie ; Neff, Brian A. ; Lane, John I. ; Carlson, Matthew L. / Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas. In: Otolaryngology - Head and Neck Surgery (United States). 2016 ; Vol. 155, No. 6. pp. 1021-1027.
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title = "Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas",
abstract = "Objective Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome. Study Design Case series with chart review. Setting Academic referral center. Subjects and Methods A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed. Results Excluding strictly intracanalicular tumors (n = 32, 16{\%}) and those with NF2 (n = 10, 4.9{\%}), the presence of dural enhancement was radiographically confirmed in 16 (9.8{\%}) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31{\%}) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3{\%}) of the matched controls (P =.01). Four (25{\%}) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3{\%}, P =.04). Long-term facial nerve function was similar between cases and controls (81{\%} vs 84{\%} House-Brackmann I-II function, P = 1.00). Conclusion Dural enhancement is present in approximately 10{\%} of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.",
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AU - Patel, Neil S.

AU - Van Abel, Kathryn M.

AU - Link, Michael J.

AU - Driscoll, Colin L W

AU - Van Gompel, Jamie

AU - Neff, Brian A.

AU - Lane, John I.

AU - Carlson, Matthew L.

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N2 - Objective Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome. Study Design Case series with chart review. Setting Academic referral center. Subjects and Methods A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed. Results Excluding strictly intracanalicular tumors (n = 32, 16%) and those with NF2 (n = 10, 4.9%), the presence of dural enhancement was radiographically confirmed in 16 (9.8%) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31%) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3%) of the matched controls (P =.01). Four (25%) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3%, P =.04). Long-term facial nerve function was similar between cases and controls (81% vs 84% House-Brackmann I-II function, P = 1.00). Conclusion Dural enhancement is present in approximately 10% of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.

AB - Objective Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome. Study Design Case series with chart review. Setting Academic referral center. Subjects and Methods A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed. Results Excluding strictly intracanalicular tumors (n = 32, 16%) and those with NF2 (n = 10, 4.9%), the presence of dural enhancement was radiographically confirmed in 16 (9.8%) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31%) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3%) of the matched controls (P =.01). Four (25%) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3%, P =.04). Long-term facial nerve function was similar between cases and controls (81% vs 84% House-Brackmann I-II function, P = 1.00). Conclusion Dural enhancement is present in approximately 10% of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.

KW - acoustic neuroma

KW - cranial base

KW - meningioma

KW - neurotology

KW - skull base

KW - vestibular schwannoma

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