Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery

Stephanie C. Wise, Matthew L. Carlson, Øystein Vesterli Tveiten, Colin L. Driscoll, Erling Myrseth, Morten Lund-Johansen, Michael J. Link

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives/Hypothesis: To evaluate outcomes of salvage surgery for vestibular schwannoma (VS) that failed primary stereotactic radiosurgery (SRS). Methods: Case-control study of 37 patients who underwent surgical resection of sporadic VS following prior SRS at two tertiary academic referral centers between 2003 and 2015. A cohort of nonirradiated control subjects, matched according to tumor size, age, and treatment center, were used as comparison. Results: Thirty-seven patients were included. The median time from radiation to surgical salvage was 36 months (range 9.6–153 months). Following tumor progression after SRS, 18 (49%) patients underwent gross total resection, 10 (27%) underwent near-total resection, and nine (24%) underwent subtotal resection. Postoperative complications following salvage surgery included one (3%) case of stroke, four (11%) cases of cerebrospinal fluid leak, and two (5%) cases of meningitis. Twenty-seven (73%) patients had good postoperative facial nerve outcome (House-Brackmann Score I–II) at long-term follow-up. There were no cases of tumor recurrence or regrowth after a median length of 26 months following microsurgical salvage (range 3–114 months). The rate of satisfactory postoperative facial nerve function was not different between study and control subjects (73% vs. 76%; P = 0.8); however, less-than-complete resection was utilized more frequently among previously radiated patients (P = 0.01). Conclusion: Microsurgical salvage of VS following primary radiation therapy is challenging. Less-than-complete resection is required in a greater percentage of patients to preserve facial nerve integrity and prevent neurological complications. Long-term follow-up is needed to determine the risk of delayed progression following incomplete tumor removal. Level of Evidence: 3b. Laryngoscope, 126:2580–2586, 2016.

Original languageEnglish (US)
Pages (from-to)2580-2586
Number of pages7
JournalLaryngoscope
Volume126
Issue number11
DOIs
StatePublished - Nov 1 2016

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Acoustic Neuroma
Radiosurgery
Facial Nerve
Neoplasms
Laryngoscopes
Meningitis
Tertiary Care Centers
Case-Control Studies
Radiotherapy
Stroke
Radiation
Recurrence

Keywords

  • acoustic neuroma
  • gamma knife
  • microsurgery
  • radiosurgery
  • recurrence
  • Vestibular schwannoma

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Wise, S. C., Carlson, M. L., Tveiten, Ø. V., Driscoll, C. L., Myrseth, E., Lund-Johansen, M., & Link, M. J. (2016). Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery. Laryngoscope, 126(11), 2580-2586. https://doi.org/10.1002/lary.25943

Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery. / Wise, Stephanie C.; Carlson, Matthew L.; Tveiten, Øystein Vesterli; Driscoll, Colin L.; Myrseth, Erling; Lund-Johansen, Morten; Link, Michael J.

In: Laryngoscope, Vol. 126, No. 11, 01.11.2016, p. 2580-2586.

Research output: Contribution to journalArticle

Wise, SC, Carlson, ML, Tveiten, ØV, Driscoll, CL, Myrseth, E, Lund-Johansen, M & Link, MJ 2016, 'Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery', Laryngoscope, vol. 126, no. 11, pp. 2580-2586. https://doi.org/10.1002/lary.25943
Wise SC, Carlson ML, Tveiten ØV, Driscoll CL, Myrseth E, Lund-Johansen M et al. Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery. Laryngoscope. 2016 Nov 1;126(11):2580-2586. https://doi.org/10.1002/lary.25943
Wise, Stephanie C. ; Carlson, Matthew L. ; Tveiten, Øystein Vesterli ; Driscoll, Colin L. ; Myrseth, Erling ; Lund-Johansen, Morten ; Link, Michael J. / Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery. In: Laryngoscope. 2016 ; Vol. 126, No. 11. pp. 2580-2586.
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abstract = "Objectives/Hypothesis: To evaluate outcomes of salvage surgery for vestibular schwannoma (VS) that failed primary stereotactic radiosurgery (SRS). Methods: Case-control study of 37 patients who underwent surgical resection of sporadic VS following prior SRS at two tertiary academic referral centers between 2003 and 2015. A cohort of nonirradiated control subjects, matched according to tumor size, age, and treatment center, were used as comparison. Results: Thirty-seven patients were included. The median time from radiation to surgical salvage was 36 months (range 9.6–153 months). Following tumor progression after SRS, 18 (49{\%}) patients underwent gross total resection, 10 (27{\%}) underwent near-total resection, and nine (24{\%}) underwent subtotal resection. Postoperative complications following salvage surgery included one (3{\%}) case of stroke, four (11{\%}) cases of cerebrospinal fluid leak, and two (5{\%}) cases of meningitis. Twenty-seven (73{\%}) patients had good postoperative facial nerve outcome (House-Brackmann Score I–II) at long-term follow-up. There were no cases of tumor recurrence or regrowth after a median length of 26 months following microsurgical salvage (range 3–114 months). The rate of satisfactory postoperative facial nerve function was not different between study and control subjects (73{\%} vs. 76{\%}; P = 0.8); however, less-than-complete resection was utilized more frequently among previously radiated patients (P = 0.01). Conclusion: Microsurgical salvage of VS following primary radiation therapy is challenging. Less-than-complete resection is required in a greater percentage of patients to preserve facial nerve integrity and prevent neurological complications. Long-term follow-up is needed to determine the risk of delayed progression following incomplete tumor removal. Level of Evidence: 3b. Laryngoscope, 126:2580–2586, 2016.",
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AB - Objectives/Hypothesis: To evaluate outcomes of salvage surgery for vestibular schwannoma (VS) that failed primary stereotactic radiosurgery (SRS). Methods: Case-control study of 37 patients who underwent surgical resection of sporadic VS following prior SRS at two tertiary academic referral centers between 2003 and 2015. A cohort of nonirradiated control subjects, matched according to tumor size, age, and treatment center, were used as comparison. Results: Thirty-seven patients were included. The median time from radiation to surgical salvage was 36 months (range 9.6–153 months). Following tumor progression after SRS, 18 (49%) patients underwent gross total resection, 10 (27%) underwent near-total resection, and nine (24%) underwent subtotal resection. Postoperative complications following salvage surgery included one (3%) case of stroke, four (11%) cases of cerebrospinal fluid leak, and two (5%) cases of meningitis. Twenty-seven (73%) patients had good postoperative facial nerve outcome (House-Brackmann Score I–II) at long-term follow-up. There were no cases of tumor recurrence or regrowth after a median length of 26 months following microsurgical salvage (range 3–114 months). The rate of satisfactory postoperative facial nerve function was not different between study and control subjects (73% vs. 76%; P = 0.8); however, less-than-complete resection was utilized more frequently among previously radiated patients (P = 0.01). Conclusion: Microsurgical salvage of VS following primary radiation therapy is challenging. Less-than-complete resection is required in a greater percentage of patients to preserve facial nerve integrity and prevent neurological complications. Long-term follow-up is needed to determine the risk of delayed progression following incomplete tumor removal. Level of Evidence: 3b. Laryngoscope, 126:2580–2586, 2016.

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