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

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 prima...

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Bibliographic Details
Published in:Journal of neuro-oncology 2019-06, Vol.143 (2), p.281-288
Main Authors: Akinduro, Oluwaseun O., Lundy, Larry B., Quinones-Hinojosa, Alfredo, Lu, Victor M., Trifiletti, Daniel M., Gupta, Vivek, Wharen, Robert E.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Brain cancer
Clinical Study
Facial nerve
Facial Nerve - physiopathology
Female
Follow-Up Studies
Humans
Male
Medical records
Medicine
Medicine & Public Health
Middle Aged
Neoplasm, Residual - pathology
Neoplasm, Residual - surgery
Neurology
Neuroma, Acoustic - pathology
Neuroma, Acoustic - surgery
Oncology
Patients
Postoperative Complications
Radiosurgery - methods
Retrospective Studies
Schwann cells
Surgery
Treatment Outcome
Tumor Burden
Tumors
Vestibular system
Young Adult
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Summary: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 
ISSN:0167-594X
1573-7373
DOI:10.1007/s11060-019-03157-4