Vestibular Schwannoma Management: An Evidence-Based Comparison of Stereotactic Radiosurgery and Microsurgical Resection

2008 ◽  
pp. 222-227 ◽  
Author(s):  
Bruce E. Pollock
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Evidence Based ◽  
Microsurgical Resection

Patient Outcomes After Vestibular Schwannoma Management: a Prospective Comparison of Microsurgical Resection and Stereotactic Radiosurgery

Neurosurgery ◽  
2006 ◽  
Vol 59 (1) ◽  
pp. 77-85 ◽  
Author(s):  
Bruce E. Pollock ◽  
Colin L.W. Driscoll ◽  
Robert L. Foote ◽  
Michael J. Link ◽  
Deborah A. Gorman ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Patient Outcomes ◽  
Vestibular Schwannoma ◽  
Prospective Comparison ◽  
Microsurgical Resection

Comparison of the surgical and follow-up costs associated with microsurgical resection and stereotactic radiosurgery for vestibular schwannoma

2008 ◽  
Vol 108 (6) ◽  
pp. 1220-1224 ◽  
Author(s):  
Ritesh Banerjee ◽  
James P. Moriarty ◽  
Robert L. Foote ◽  
Bruce E. Pollock
Keyword(s):  
Confidence Interval ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Mayo Clinic ◽  
Long Term Follow Up ◽  
Patient Groups ◽  
Microsurgical Resection ◽  
Mean Cost

Object The best approach to the management of vestibular schwannoma (VS) remains controversial. The aim of this study is to analyze the initial and follow-up costs of resection and stereotactic radiosurgery for patients with VS. Methods Initial and follow-up costs in 53 cases in which patients with unilateral, previously unoperated VSs > 3 cm underwent resection (21 cases) or radiosurgery (32 cases) at the Mayo Clinic from June 2000 until July 2002 were analyzed for 36 months. Follow-up treatment-specific utilization records were gathered prospectively for patients not returning to the Mayo Clinic after treatment. Six-month moving averages of incremental follow-up costs were calculated for the 2 patient groups. Results The mean cost of surgery in the microsurgery group was $23,788 (95% confidence interval $22,280–$24,842) compared with $16,143 (95% confidence interval $15,277–$17,545) for the radiosurgical group. Mean incremental follow-up costs per month for patients in the microsurgery group started just > $1000 per month, decreased steadily, and remained < $70 per month by the 10th month of follow-up. Mean incremental follow-up costs per month for patients in the radiosurgery group were <$10 per month for the first few months and thereafter increased to as much as $200 per month. Conclusions Although the total cost of microsurgery is higher due to the costs of hospitalization, follow-up costs for radiosurgery are greater in general. From a societal perspective, radiosurgery is less expensive than microsurgical resection provided that the rate of tumor progression after radiosurgery remains low with long-term follow-up.

Vestibular schwannoma surgery in the elderly: a matched cohort study

2014 ◽  
Vol 120 (1) ◽  
pp. 207-217 ◽  
Author(s):  
Kathryn M. Van Abel ◽  
Matthew L. Carlson ◽  
Colin L. Driscoll ◽  
Brian A. Neff ◽  
Michael J. Link
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Tumor Size ◽  
The Elderly ◽  
Adult Patients ◽  
Matched Cohort ◽  
Physical Status ◽  
Microsurgical Resection

Object The authors' objective was 2-fold: 1) to compare outcomes of microsurgical resection for vestibular schwannoma (VS) between patients aged 70 years or older and patients younger than 70 years and 2) to test the hypothesis that symptomatic tumors in elderly patients represent a more aggressive variant of VS than those in younger adults, resulting in increased morbidity and a higher rate of recurrence after subtotal resection (STR). Methods A retrospective matched cohort study was conducted. Patients aged 70 years or older who had undergone microsurgical resection of VS were matched to adult patients younger than 70 years; the matching was performed on the basis of surgical approach, completeness of resection, and tumor size. Associations between clinical, radiographic, and surgical data and postoperative outcome were analyzed using conditional logistic regression. Results Twenty patients aged 70 years or older (mean age ± SD 75.9 ± 5.3, range 70–86 years) were identified and matched to a cohort of younger adult patients (mean age ± SD 55.7 ± 13.8, range 25–69 years). The mean tumor size in both groups was approximately 3 cm. Overall, the elderly patients had a poorer preoperative American Society of Anesthesiology physical status score (p = 0.038), were more likely to report imbalance (OR 9.61, p = 0.016), and more commonly exhibited compromised balance and coordination (OR 9.61, p = 0.016) than patients in the younger cohort. There were no differences between the 2 cohorts in perioperative complications (p = 0.26) or facial nerve function (p > 0.5) at any time. The elderly patients were 13 times more likely to have long-term postoperative imbalance (OR 13.00, p = 0.013) than the younger patients. Overall, 9 tumors recurred among 32 patients undergoing STR; 6 of these patients underwent additional interventions (stereotactic radiosurgery in 5 patients and microsurgery in 1) and showed no evidence of tumor progression at the last follow-up. The median growth rate of the recurrent tumor in the 6 elderly patients was 4.8 mm/year (range 2.1–14.9 mm/year) and, in the 3 control patients, 2.2 mm/year (range 1.9–4.0 mm/year). Overall, the mortality data showed a trend toward statistical significance (p = 0.068) with a higher risk of death in the elderly. Conclusions As the number of elderly patients with VS increases, microsurgical resection will remain an important management option for these patients. Despite a poorer preoperative physical status in elderly patients, their morbidity profiles are similar to those in adult patients younger than 70 years. However, elderly patients may require longer convalescence due to prolonged postoperative imbalance. Not surprisingly, overall diminished functional reserve and advanced comorbidities may increase the mortality risk associated with surgical intervention in the elderly patients. Finally, there was a high risk of further tumor growth following STR in the elderly patients (6 [37.5%] of 16), underscoring the need for close postoperative radiological surveillance and consideration of early stereotactic radiosurgery for the tumor remnant following the STR.

Long-Term Quality of Life Following Stereotactic Radiosurgery for Vestibular Schwannoma

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
J. Thom ◽  
M. Carlson ◽  
J. Jacob ◽  
C. Driscoll ◽  
B. Neff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma

Is Partial Resection and Stereotactic Radiosurgery a Good Option for Growing Vestibular Schwannoma?

Skull Base ◽  
2009 ◽  
Vol 19 (01) ◽  
Author(s):  
Eduard Zverina ◽  
Jan Betka ◽  
Martin Chovanec ◽  
Josef Kraus ◽  
Jan Kluh ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Partial Resection ◽  
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