Functional sparing surgery policy for giant vestibular schwannomas.
facial nerve
gross total resection
stereotactic radiosurgery
subtotal resection
tumour control
vestibular schwannoma
Journal
Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
ISSN: 1749-4486
Titre abrégé: Clin Otolaryngol
Pays: England
ID NLM: 101247023
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
07
05
2020
accepted:
17
05
2020
pubmed:
26
5
2020
medline:
9
10
2021
entrez:
26
5
2020
Statut:
ppublish
Résumé
The objective of this study was to compare the tumour control and facial nerve outcome according to the therapeutic strategy, that is extent of resection and post-operative radiotherapy. Retrospective study of patients with a giant vestibular schwannoma surgically treated from 4 academic skull base centres. Extent of resection, neurological complications, facial nerve function, MRI follow-up and occurrence of complementary treatment were reviewed. Sixty patients were included from 2000 to 2018. Primary end points were comparison the tumour control rate and the post-operative House-Brackmann grade at last follow-up according to the extent of tumour removal (ie total or subtotal removal). Secondary end points were assessment risk factors of poor facial nerve function and comparison complication rate according to extent of tumour removal. Sixty patients had initial surgery at diagnosis. A total resection was realised in 21 cases and a subtotal resection in 39 cases. Thirteen patients needed further treatment. One patient had a recurrence and needed a second surgery 108 months after the initial total resection surgery. Twelve patients underwent post-operative radiotherapy, for an evolutive residual tumour. Tumour control was more successful in the total resection group (log-rank test, P = .015). There was no tumour recurrence after post-operative radiotherapy. The facial nerve outcome was significantly better in the subtotal resection group (Mean House-Brackmann grade at last follow-up: 2.2 ± 1.9) than in the total resection group (House-Brackmann grade: 3.5 ± 2.2) (P = .033). Vestibular schwannoma with a cystic component had better facial nerve outcome (P = .0082). Other than facial paralysis, neurological complications were observed in six patients (10% of patients): lower cranial nerves dysfunction in five cases and hemiparesis in one case. Subtotal resection of giant vestibular schwannomas leads to favourable tumour control and facial nerve function and therefore seems to be a valuable strategy.
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
762-767Informations de copyright
© 2020 John Wiley & Sons Ltd.
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