TY - JOUR
T1 - Facial nerve outcome and tumor control rate as a function of degree of resection in treatment of large acoustic neuromas
T2 - Preliminary report of the Acoustic Neuroma Subtotal Resection Study (ANSRS)
AU - Monfared, Ashkan
AU - Corrales, Eduardo
AU - Theodosopoulos, Philip
AU - Blevins, Nikolas H.
AU - Oghalai, John S.
AU - Selesnick, Samuel H.
AU - Lee, Howard
AU - Gurgel, Richard K.
AU - Hansen, Marlan R.
AU - Nelson, Rick F.
AU - Gantz, Bruce
AU - Kutz, Walter
AU - Isaacson, Brandon
AU - Roland, Peter
AU - Amdur, Richard
AU - Jackler, Robert
N1 - Publisher Copyright:
© Copyright 2015 by the Congress of Neurological Surgeons.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - BACKGROUND: Patients with large vestibular schwannomas are at high risk of poor facial nerve (cranial nerve VII [CNVII]) function after surgery. Subtotal resection potentially offers better outcome, but may lead to higher tumor regrowth. OBJECTIVE: To assess long-term CNVII function and tumor regrowth in patients with large vestibular schwannomas. METHODS: Prospective multicenter nonrandomized cohort study of patients with vestibular schwannoma ≥2.5 cm who received gross total resection, near total resection, or subtotal resection. Patients received radiation if tumor remnant showed signs of regrowth. RESULTS: Seventy-three patients had adequate follow-up with mean tumor diameter of 3.33 cm. Twelve received gross total resection, 22 near total resection, and 39 subtotal resection. Fourteen (21%) remnant tumors continued to grow, of which 11 received radiation, 1 had repeat surgery, and 2 no treatment. Four of the postradiation remnants (36%) required surgical salvage. Tumor regrowth was related to non-cystic nature, larger residual tumor, and subtotal resection. Regrowth was 3 times as likely with subtotal resection compared to gross total resection and near total resection. Good CNVII function was achieved in 67% immediately and 81% at 1-year. Better immediate nerve function was associated with smaller preoperative tumor size and percentage of tumor left behind on magnetic resonance image. Degree of resection defined by surgeon and preoperative tumor size showed weak trend toward better late CNVII function. CONCLUSION: Likelihood of tumor regrowth was 3 times higher in subtotal resection compared to gross total resection and near total resection groups. Rate of radiation control of growing remnants was suboptimal. Better immediate but not late CNVII outcome was associated with smaller tumors and larger tumor remnants.
AB - BACKGROUND: Patients with large vestibular schwannomas are at high risk of poor facial nerve (cranial nerve VII [CNVII]) function after surgery. Subtotal resection potentially offers better outcome, but may lead to higher tumor regrowth. OBJECTIVE: To assess long-term CNVII function and tumor regrowth in patients with large vestibular schwannomas. METHODS: Prospective multicenter nonrandomized cohort study of patients with vestibular schwannoma ≥2.5 cm who received gross total resection, near total resection, or subtotal resection. Patients received radiation if tumor remnant showed signs of regrowth. RESULTS: Seventy-three patients had adequate follow-up with mean tumor diameter of 3.33 cm. Twelve received gross total resection, 22 near total resection, and 39 subtotal resection. Fourteen (21%) remnant tumors continued to grow, of which 11 received radiation, 1 had repeat surgery, and 2 no treatment. Four of the postradiation remnants (36%) required surgical salvage. Tumor regrowth was related to non-cystic nature, larger residual tumor, and subtotal resection. Regrowth was 3 times as likely with subtotal resection compared to gross total resection and near total resection. Good CNVII function was achieved in 67% immediately and 81% at 1-year. Better immediate nerve function was associated with smaller preoperative tumor size and percentage of tumor left behind on magnetic resonance image. Degree of resection defined by surgeon and preoperative tumor size showed weak trend toward better late CNVII function. CONCLUSION: Likelihood of tumor regrowth was 3 times higher in subtotal resection compared to gross total resection and near total resection groups. Rate of radiation control of growing remnants was suboptimal. Better immediate but not late CNVII outcome was associated with smaller tumors and larger tumor remnants.
KW - Acoustic neuroma
KW - Combined therapy acoustic neuroma
KW - Stereotactic radiation therapy
KW - Subtotal resection large acoustic neuroma
KW - Vestibular schwannoma
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UR - http://www.scopus.com/inward/citedby.url?scp=84949580134&partnerID=8YFLogxK
U2 - 10.1227/NEU.0000000000001162
DO - 10.1227/NEU.0000000000001162
M3 - Article
C2 - 26645964
AN - SCOPUS:84949580134
SN - 0148-396X
VL - 79
SP - 194
EP - 200
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -