Changing Enhancement Pattern and Tumor Volume of Vestibular Schwannomas After Subtotal Resection

• Published in: World neurosurgery 2021-07, Vol.151, p.e466-e471
• Main Authors: Heller, Robert S., Joud, Hadi, Flores-Milan, Gabriel, Franzese, Ryan, Ford, Jonathan, Nelson, Jay, Decker, Summer, Mhaskar, Rahul, van Loveren, Harry, Agazzi, Siviero
• Format: Article
• Language: English
• Subjects: Contrast enhancement subtotal resection; Vestibular schwannoma; Volumetric analysis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2021.04.059

Surgical strategy in vestibular schwannomas may require subtotal resection to preserve neurologic function. Residual tumor growth pattern and contrast enhancement in the immediate postresection period remain uncertain. We sought to evaluate changes in the enhancement pattern and volume of vestibular schwannomas after subtotal resection in the immediate postoperative period. Volumetric analysis of tumor size and enhancement patterns of vestibular schwannomas were measured on magnetic resonance imaging (MRI) scans obtained within 3 days of surgery, 3 months after surgery, and 1 year after surgery. Nineteen patients were eligible for inclusion in the study (9 male and 10 female) with an average age of 47 years. Contrast enhancement was absent in 6 of 19 (32%) of cases on the immediate postresection MRI with return of expected enhancement on subsequent studies. Volumetric analysis identified that tumors decreased in size by an average of 35% in the first 3 months (P = 0.025) after resection and 46% in the first year after resection (P < 0.01). Vestibular schwannomas that undergo subtotal resection tend to decrease in size over the first 3 months after resection. Residual tumor volume may fail to enhance on the immediate postresection MRI. Both of these findings could lead surgeons to misinterpret degree of resection after surgery and have implications for clinical decision making and research reporting in the scientific literature for vestibular schwannomas after subtotal resection.