Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature

2012 ◽  
Vol 33 (3) ◽  
pp. E13 ◽  
Author(s):  
Parham Yashar ◽  
Gabriel Zada ◽  
Brianna Harris ◽  
Steven L. Giannotta
Keyword(s):  
Facial Nerve ◽  
Extent Of Resection ◽  
Vestibular Schwannomas ◽  
Benign Tumors ◽  
Fisher Exact Test ◽  
Tumor Diameter ◽  
Total Resection ◽  
Exact Test ◽  
Translabyrinthine Approach ◽  
Operative Notes

Object Vestibular schwannomas (VSs) are benign tumors of the eighth cranial nerve sheath, representing approximately 6%–8% of all newly diagnosed brain tumors, with an annual incidence of 2000–2500 cases in the US. Although most of these lesions are solid, cystic vestibular schwannomas (CVSs) compose 4%–20% of all VSs and are commonly larger at the time of presentation. The authors present their experience with the operative management of CVSs, including surgical approach, extent of resection, and postoperative facial nerve outcomes. The literature pertaining to clinical and histopathological differences between CVSs and their solid counterparts is reviewed. Methods The University of Southern California Department of Neurosurgery database was retrospectively reviewed to identify patients who had undergone resection of a VS between 2000 and 2010. One hundred seventy-nine patients with VS were identified. Patients with CVSs were the subject of the present analysis. Diagnosis of a CVS was made based on MRI findings. Clinical and neuroimaging data, including pre- and postoperative assessments and operative notes, were collected and reviewed. Results Twenty-three patients, 14 men (61%) and 9 women (39%), underwent 24 operations for CVSs. These patients composed 12.8% of all cases of VS. Patient ages ranged from 28 to 78 years (mean 55 years), and the mean maximal tumor diameter was 3.6 cm (range 2.0–4.0 cm). Patients most frequently presented with headache, hearing loss, vertigo, and dizziness. Preoperative facial numbness was reported in 44% of patients. Among the 24 cases, 13 were treated with retrosigmoid craniotomy and 11 via a translabyrinthine approach. Complete resection was achieved in 11 patients (48%), subtotal resection (STR) in 8 patients (35%), and near-total resection (NTR) in 4 patients (17%). Facial nerve outcomes were available in all except one case. Good facial nerve outcomes (House-Brackmann [HB] Grades I–III) were achieved in 82% of the patients who had undergone either NTR or STR, as compared with 73% of patients who had undergone gross-total resection (GTR; p > 0.05, Fisher exact test). In comparison, 83% of patients with solid VSs had a good HB grade (p = 0.38, Fisher exact test), although this finding did not reach statistical significance. Complications included wound infection (2 patients), delayed CSF leakage (1 patient), and a delayed temporal encephalocele following a translabyrinthine approach and requiring surgical repair (1 patient). Conclusions Cystic vestibular schwannoma represents a clinical and surgical entity separate from its solid counterpart, as demonstrated by its more rapid clinical course and early surgical outcomes. Facial nerve grades may correlate with the degree of tumor resection, trending toward poorer grades with more significant resections. Although GTR is recommended whenever possible, performing an STR when facial nerve preservation is in jeopardy to improve facial nerve outcomes is the preferred strategy at the authors' institution.

scholarly journals Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

2012 ◽  
Vol 33 (3) ◽  
pp. E16 ◽  
Author(s):  
Richard K. Gurgel ◽  
Salim Dogru ◽  
Richard L. Amdur ◽  
Ashkan Monfared
Keyword(s):  
Facial Nerve ◽  
Surgical Approach ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Vestibular Schwannomas ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Total Resection ◽  
Translabyrinthine Approach ◽  
Better Than

Object The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. Methods A PubMed search was conducted of English language studies on the treatment of large VSs published from 1985 to 2011. Studies were then evaluated and included if they contained data regarding the size of the tumor, surgical approach, extent of resection, and postoperative facial nerve function. Results Of the 536 studies initially screened, 59 full-text articles were assessed for eligibility, and 30 studies were included for analysis. A total of 1688 tumor resections were reported. Surgical approach was reported in 1390 patients and was significantly associated with facial nerve outcome (ϕ= 0.29, p < 0.0001). Good facial nerve outcomes (House-Brackmann Grade I or II) were produced in 62.5% of the 555 translabyrinthine approaches, 65.2% of the 601 retrosigmoid approaches, and 27.4% of the 234 extended translabyrinthine approaches. Facial nerve outcomes from translabyrinthine and retrosigmoid approaches were not significantly different from each other, but both showed significantly more good facial nerve outcomes, compared with the extended translabyrinthine approach (OR for translabyrinthine vs extended translabyrinthine = 4.43, 95% CI 3.17–6.19, p < 0.0001; OR for retrosigmoid vs extended translabyrinthine = 4.98, 95% CI 3.57–6.95, p < 0.0001). There were 471 patients for whom extent of resection was reported. There was a strong and significant association between degree of resection and outcome (ϕ= 0.38, p < 0.0001). Of the 80 patients receiving subtotal resections, 92.5% had good facial nerve outcomes, compared with 74.6% (n = 55) and 47.3% (n = 336) of those who received near-total resections and gross-total resections, respectively. In the 2-way comparison of good versus suboptimal/poor outcomes (House-Brackmann Grade III–VI), subtotal resection was significantly better than near-total resection (OR = 4.21, 95% CI 1.50–11.79; p = 0.004), and near-total resection was significantly better than gross-total resection (OR = 3.26, 95% CI 1.71–6.20; p = 0.0002) in producing better facial nerve outcomes. Conclusions In a pooled patient population from studies evaluating the treatment of large VSs, subtotal and near-total resections were shown to produce better facial nerve outcomes when compared with gross-total resections. The translabyrinthine and retrosigmoid surgical approaches are likely to result in similar rates of good facial nerve outcomes. Both of these approaches show better facial nerve outcomes when compared with the extended translabyrinthine approach, which is typically reserved for especially large tumors. The reported literature on treatment of large VSs is extremely heterogeneous and minimal consistency in reporting outcomes was observed.

Facial Nerve Outcome and Tumor Control Rate as a Function of Degree of Resection in Treatment of Large Acoustic Neuromas

Neurosurgery ◽  
2015 ◽  
Vol 79 (2) ◽  
pp. 194-203 ◽  
Author(s):  
Ashkan Monfared ◽  
Carlton E. Corrales ◽  
Philip V. Theodosopoulos ◽  
Nikolas H. Blevins ◽  
John S. Oghalai ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Size ◽  
Gross Total Resection ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Tumor Diameter ◽  
Total Resection ◽  
Repeat Surgery ◽  
Tumor Regrowth

Abstract 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.

Do cystic vestibular schwannomas have worse surgical outcomes? Systematic analysis of the literature

2012 ◽  
Vol 33 (3) ◽  
pp. E12 ◽  
Author(s):  
Jai Deep Thakur ◽  
Imad Saeed Khan ◽  
Cedric D. Shorter ◽  
Ashish Sonig ◽  
Gale L. Gardner ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Surgical Outcomes ◽  
English Language ◽  
Extent Of Resection ◽  
Mortality Rates ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Systematic Analysis ◽  
Significant Difference ◽  
The Mean

Object The goal of this study was to perform a systematic quantitative comparison of the surgical outcomes between cystic vestibular schwannomas (CVSs) and solid vestibular schwannomas (SVSs). Methods A review of English-language literature published between 1990 and 2011 was performed using various search engines including PubMed, Google Scholar, and the Cochrane database. Only studies that reported surgical results of CVSs in comparison with SVSs were included in the analysis. The primary end point of this study was surgical outcomes, defined by the following: 1) facial nerve outcomes at latest follow-up; 2) mortality rates; or 3) non–facial nerve complication index. Secondary end points included extent of resection and brainstem adherence. Results Nine studies comprising 428 CVSs and 1287 SVSs were included in the study. The mean age of patients undergoing surgery was 48.3 ± 6.75 and 47.1 ± 9 years for CVSs and SVSs, respectively (p = 0.8). The mean tumor diameter for CVSs was 3.9 ± 0.84 cm and that for SVSs was 3.7 ± 1.2 cm (p = 0.7). There was no significant difference in the extent of resection among CVSs and SVSs (81.2% vs 80.7%, p = 0.87) Facial nerve outcomes were significantly better in the cohort of patients with SVSs than in those with CVSs (52.1% vs 39%, p = 0.0001). The perioperative mortality rates for CVSs and SVSs were not significantly different (3% and 3.8%, respectively; p = 0.6). No significant difference was noted between the cumulative non–facial nerve complication rate (including mortality) among patients with CVSs and SVSs (24.5% and 25.6%, respectively; p = 0.75) Conclusions Facial nerve outcomes are worse in patients undergoing resection for CVSs than in patients undergoing resection for SVSs. There were no significant differences in the extent of resection or postoperative morbidity and mortality rates between the cohorts of patients with vestibular schwannomas.

scholarly journals Facial nerve outcome and extent of resection in cystic versus solid vestibular schwannomas in radiosurgery era

2018 ◽  
Vol 44 (3) ◽  
pp. E3 ◽  
Author(s):  
Pinar Eser Ocak ◽  
Ihsan Dogan ◽  
Umut Ocak ◽  
Cem Dinc ◽  
Mustafa K. Başkaya
Keyword(s):  
Facial Nerve ◽  
Cyst Formation ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Vestibular Schwannomas ◽  
Total Resection ◽  
Mean Size ◽  
Microsurgical Resection ◽  
Poor Outcomes

OBJECTIVECystic vestibular schwannomas (CVSs) are a subgroup of vestibular schwannomas (VSs) that are reported to be associated with unpredictable clinical behavior and unfavorable postoperative outcomes. The authors aimed to review their experience with microsurgical treatment of CVSs in terms of extent of resection and postoperative facial nerve (FN) function and compare these outcomes with those of their solid counterparts.METHODSTwo hundred-eleven VS patients were treated surgically between 2006 and 2017. Tumors were defined as cystic when preoperative neuroimaging demonstrated cyst formation that was confirmed by intraoperative findings. Solid VS (SVSs) with similar classes were used for comparison. Clinical data of the patients were reviewed retrospectively, including clinical notes and images, as well as operative, pathology, and neuroradiology reports.RESULTSThirty-two patients (20 males and 12 females) with a mean age of 52.2 years (range 17–77 years) underwent microsurgical resection of 33 CVSs (mean size 3.6 cm, range 1.5–5 cm). Forty-nine patients (26 males and 23 females) with a mean age of 49.9 years (range 21–75 years) underwent microsurgical resection of 49 SVSs (mean size 3 cm, range 2–4.5 cm). All operations were performed via either a retrosigmoid or a translabyrinthine approach. Gross-total resection was achieved in 30 cases in the CVS group (90.9%) and 37 in the SVS group (75.5%). The main reason for subtotal and near-total resection was adherence of the tumor to the brainstem and/or FN in both groups. None of the patients with subtotal or near-total resection in the CVS group demonstrated symptomatic regrowth of the tumor during the mean follow-up period of 41.6 months (range 18–82 months). The FN was anatomically preserved in all patients in both groups. Good FN outcomes were achieved in 15 of CVS (grade I–II; 45.5%) and 35 of SVS (71.4%) surgeries at discharge. Good and fair FN functions were noted in 22 (grade I–II; 81.5%) and 5 (grade III only; 18.5%) of the CVS patients, respectively, at the 1-year follow-up; none of the patients showed poor FN function.CONCLUSIONSSurgery of CVSs does not necessarily result in poor outcomes in terms of the extent of resection and FN function. Special care should be exercised to preserve anatomical continuity of the FN during surgery, since long-term FN function outcomes are much more satisfactory than short-term results. High rates of gross-total resection and good FN outcomes in our study may also suggest that microsurgery stands as the treatment of choice in select cases of large CVSs and SVSs in the era of radiosurgery.

Comparison of Surgical Outcomes and Recurrence Rates of Cystic and Solid Vestibular Schwannomas

2019 ◽  
Author(s):  
Rami O. Almefty ◽  
David S. Xu ◽  
Michael A. Mooney ◽  
Andrew Montoure ◽  
Komal Naeem ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Facial Nerve ◽  
Tumor Progression ◽  
Clinical Outcomes ◽  
Univariate Analysis ◽  
Growth Patterns ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Cystic Tumors

Abstract Objective Cystic vestibular schwannomas (CVSs) are anecdotally believed to have worse clinical and tumor-control outcomes than solid vestibular schwannomas (SVSs); however, no data have been reported to support this belief. In this study, we characterize the clinical outcomes of patients with CVSs versus those with SVSs. Design This is a retrospective review of prospectively collected data. Setting This study is set at single high-volume neurosurgical institute. Participants We queried a database for details on all patients diagnosed with vestibular schwannomas between January 2009 and January 2014. Main Outcome Measures Records were retrospectively reviewed and analyzed using univariate and multivariate analyses to study the differences in clinical outcomes and tumor progression or recurrence. Results Of a total of 112 tumors, 24% (n = 27) were CVSs and 76% (n = 85) were SVSs. Univariate analysis identified the extent of resection, Koos grade, and tumor diameter as significant predictors of recurrence (p ≤ 0.005). However, tumor diameter was the only significant predictor of recurrence in the multivariate analysis (p = 0.007). Cystic change was not a predictor of recurrence in the univariate or multivariate analysis (p ≥ 0.40). Postoperative facial nerve and hearing outcomes were similar for both CVSs and SVSs (p ≥ 0.47). Conclusion Postoperative facial nerve outcome, hearing, tumor progression, and recurrence are similar for patients with CVSs and SVSs. As CVS growth patterns and responses to radiation are unpredictable, we favor microsurgical resection over radiosurgery as the initial treatment. Our data do not support the commonly held belief that cystic tumors behave more aggressively than solid tumors or are associated with increased postoperative facial nerve deficits.

Intended Near-Total Removal of Koos Grade IV Vestibular Schwannomas: Reconsidering the Treatment Paradigm

Neurosurgery ◽  
2017 ◽  
Vol 82 (2) ◽  
pp. 202-210 ◽  
Author(s):  
Daniel Walter Zumofen ◽  
Tommaso Guffi ◽  
Christian Epple ◽  
Birgit Westermann ◽  
Anna-Katharina Krähenbühl ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Vestibular Schwannomas ◽  
Facial Nerve Function ◽  
Total Removal ◽  
Treatment Paradigm ◽  
The Mean

Abstract BACKGROUND The goals of treating Koos grade IV vestibular schwannomas are to relieve brainstem compression, preserve or restore neurological function, and achieve long-term tumor control while minimizing tumor- and treatment-related morbidity. OBJECTIVE To propose a treatment paradigm involving the intentional near-total removal of Koos grade IV vestibular schwannomas, in which a small amount of residual tumor is not dissected off the cisternal portion of the facial nerve. Patients are then followed by a wait-and-scan approach. Any subsequent volumetric progression of the residual tumor is treated with radiosurgery. METHODS This is a case series of 44 consecutive unselected patients who underwent intended near-total resection of a Koos grade IV vestibular schwannoma through a retrosigmoid approach from January 2009 to December 2015. Pre- and postoperative volumetric analyses were performed on routine magnetic resonance imaging sequences (constructive interference in steady state and gadolinium-enhanced T1-weighted sequence). RESULTS The mean preoperative tumor volume was 10.9 cm3. The mean extent of resection was 89%. At the last clinical follow-up, facial nerve function was good [House and Brackmann (HB) I-II] in 89%, fair (HB III) in 9%, and poor (HB IV-VI) in 2% of the patients. At the last radiological follow-up, the residual tumor had become smaller or remained the same size in 84% of patients. Volumetric progression was negatively correlated with the original extent of resection and positively correlated with postoperative residual tumor volume (P = .01, P &lt; .001, respectively). CONCLUSION Intended near-total removal results in excellent preservation of facial nerve function and has a low recurrence rate. Any progressive residual tumor may be treated by radiosurgery.

Endoscopic endonasal surgery for nonadenomatous, nonmeningeal pathology involving the cavernous sinus

2017 ◽  
Vol 126 (3) ◽  
pp. 880-888 ◽  
Author(s):  
Aikaterini Patrona ◽  
Kunal S. Patel ◽  
Evan D. Bander ◽  
Alpesh Mehta ◽  
Apostolos John Tsiouris ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Tumor Board ◽  
Benign Tumors ◽  
Total Resection ◽  
Cranial Neuropathies ◽  
The Mean ◽  
Underlying Pathology

OBJECTIVE Surgery within the cavernous sinus (CS) remains a controversial topic because of the delicate and complex anatomy. The risk also varies with tumor consistency. Softer tumors such as pituitary adenomas are more likely to be surgically treated, while firm tumors such as meningiomas are often treated with radiosurgery. However, a wide range of pathologies that can involve the CS are amenable to surgery. The authors describe and analyze their results using endonasal endoscopic “medial-to-lateral” approaches for nonadenomatous, nonmeningeal tumors, in relation to the degree of invasion within the CS. METHODS A prospectively acquired database of consecutive endoscopic approaches for tumors with verified intraoperative CS invasion was reviewed. Pituitary adenomas and meningiomas were excluded. Degree of invasion of the CS was classified using the Knosp-Steiner (KS) grading system as well as the percentage of cavernous carotid artery (CCA) encasement. Extent of resection of the entire tumor and of the CS component was assessed by independent neuroradiologists using volumetric measurements of the pre- and postoperative MRI studies. Demographic data and complications were noted. RESULTS Fifteen patients (mean age 51.1 years who received endoscopic surgery between 2007 and 2013 met the selection criteria. There were 11 malignant tumors, including chordoma, chondrosarcoma, hemangiopericytoma, lymphoma, and metastatic cancer, and 4 benign tumors, including 3 cavernous hemangiomas and 1 dermoid. All cases were discussed before treatment in a tumor board. Adjuvant treatment options included chemotherapy and radiotherapy. The mean pre- and postoperative tumor volumes were 12.74 ml and 3.86 ml. Gross-total resection (GTR; ie, resection greater than 95%) was the goal in 13 cases and was achieved in 6 patients (46%) while in addition 5 patients had a greater than 80% resection. Gross-total resection in the CS was accomplished in 55% of the tumors with KS Grades 1–2 and in 16.6% of the tumors with KS grades 3–4, respectively. Likewise, GTR was accomplished in 55% of the tumors with CCA encasement under 75% and in 14.3% of the lesions with CCA encasement over 75%, irrespective of tumor volume and underlying pathology. There were 18 preexisting cranial neuropathies involving cranial nerves III–VI, of which 9 fully resolved, 4 improved, and 3 remained unchanged; 2 of these worsened with tumor recurrence. Surgical complications included 1 transient new cranial nerve VI palsy associated with Horner's syndrome and 1 case of panhypopituitarism. There were no postoperative CSF leaks and no infections. The mean extended follow-up was 34.4 months. CONCLUSIONS Endonasal endoscopic approaches can play a role in the management of nonmeningeal, nonadenomatous tumors invading the CS, either through biopsy, debulking, or GTR. An advantage of this method is the relief of preexisting cranial neuropathies with low risk for new neurological deficit. Extent of resection within the CS varies with KS grade and degree of carotid encasement irrespective of the underlying pathology. The goals of surgery should be clearly established preoperatively in consultation with radiation and medical oncologists.

scholarly journals Preserve or sacrifice the stalk? Endocrinological outcomes, extent of resection, and recurrence rates following endoscopic endonasal resection of craniopharyngiomas

2019 ◽  
Vol 131 (4) ◽  
pp. 1163-1171 ◽  
Author(s):  
Edgar G. Ordóñez-Rubiano ◽  
Jonathan A. Forbes ◽  
Peter F. Morgenstern ◽  
Leopold Arko ◽  
Georgiana A. Dobri ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Extent Of Resection ◽  
Endocrine Function ◽  
Subtotal Resection ◽  
Type I ◽  
Pituitary Insufficiency ◽  
Recurrence Rates ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Operative Notes

OBJECTIVEGross-total resection (GTR) of craniopharyngiomas (CPs) is potentially curative and is often the goal of surgery, but endocrinopathy generally results if the stalk is sacrificed. In some cases, GTR can be attempted while still preserving the stalk; however, stalk manipulation or devascularization may cause endocrinopathy and this strategy risks leaving behind small tumor remnants that can recur.METHODSA retrospective review of a prospective cohort of patients who underwent initial resection of CP using the endoscopic endonasal approach over a period of 12 years at Weill Cornell Medical College, NewYork-Presbyterian Hospital, was performed. Postresection integrity of the stalk was retrospectively assessed using operative notes, videos, and postoperative MRI. Tumors were classified based on location into type I (sellar), type II (sellar-suprasellar), and type III (purely suprasellar). Pre- and postoperative endocrine function, tumor location, body mass index, rate of GTR, radiation therapy, and complications were reviewed.RESULTSA total of 54 patients who had undergone endoscopic endonasal procedures for first-time resection of CP were identified. The stalk was preserved in 33 (61%) and sacrificed in 21 (39%) patients. GTR was achieved in 24 patients (73%) with stalk preservation and 21 patients (100%) with stalk sacrifice (p = 0.007). Stalk-preservation surgery achieved GTR and maintained completely normal pituitary function in only 4 (12%) of 33 patients. Permanent postoperative diabetes insipidus was present in 16 patients (49%) with stalk preservation and in 20 patients (95%) following stalk sacrifice (p = 0.002). In the stalk-preservation group, rates of progression and radiation were higher with intentional subtotal resection or near-total resection compared to GTR (67% vs 0%, p < 0.001, and 100% vs 12.5%, p < 0.001, respectively). However, for the subgroup of patients in whom GTR was achieved, stalk preservation did not lead to significantly higher rates of recurrence (12.5%) compared with those in whom it was sacrificed (5%, p = 0.61), and stalk preservation prevented anterior pituitary insufficiency in 33% and diabetes insipidus in 50%.CONCLUSIONSWhile the decision to preserve the stalk reduces the rate of postoperative endocrinopathy by roughly 50%, nevertheless significant dysfunction of the anterior and posterior pituitary often ensues. The decision to preserve the stalk does not guarantee preserved endocrine function and comes with a higher risk of progression and need for adjuvant therapy. Nevertheless, to reduce postoperative endocrinopathy attempts should be made to preserve the stalk if GTR can be achieved.

scholarly journals Facial Nerve Outcome and Results in Hypervascular Large Vestibular Schwannomas: Our Personal Experience in A Series of 32 Cases.

2021 ◽  
Author(s):  
Luciano Mastronardi ◽  
Alberto Campione ◽  
Fabio Boccacci ◽  
Carlo Giacobbo Scavo ◽  
Ettore Carpineta ◽  
...  
Keyword(s):  
Growth Rate ◽  
Facial Nerve ◽  
Personal Experience ◽  
Negative Impact ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Excessive Bleeding ◽  
Group A ◽  
Group B ◽  
Mib 1

Abstract BackgroundVestibular schwannomas (VS) are usually hypovascularized. Large VS with unusual vascular architecture are defined hyper-vascular (HVVS); excessive bleeding during microsurgery has negative impact on results. Methods Thirty-two consecutive patients were operated on for HVVS (Group-A). Results were compared with those of 25 patients (Group-B) operated on for large low-bleeding VS. Tendency to bleed and adherence of capsule to nervous structures were evaluated by reviewing video records. Cisternal facial nerve (FN) position was reported. Microsurgical removal was classified as total, near-total, subtotal or partial and MIB-1 index evaluated in all. FN results were classified according the House-Brackmann scale.Results Mean tumor diameter was 3,99cm in Group-A and 3,67 in Group-B; mean age was 42,3 and 58,1 years, respectively. Mean ASA class of Group-A was 1,72 versus 2,48 of Group-B (p<0,001). Total-NT resection was accomplished in 71,9% of HVVS versus 80,0% of Group-B. Tight capsule adhesion was observed in 68,7% HVVS versus 56,0% low-bleeding ones. Mean MIB-1 was 1,25% and 1,08%, respectively.Anterior-superior position of FN was observed in 48,6% of HVVS versus 32,0% of low-bleeding tumors (p<0,05). FN anatomical preservation was possible in 81,2% of Group-A versus 100% of Group-B (p<0,05); 62,5% of HVVS had HBI-II FN outcome versus 96,0% of low-bleeding (p<0,01). In Group-A 25,0% experienced postoperative complications versus 8,0% of Group-B (p<0,05). Recurrence/re-growth was observed in 7 HVVS versus 1 low-bleeding (p<0,05).Conclusions Microsurgery of large HVVS was associated with higher complication and recurrence/re-growth rate and poorer FN outcome, especially in cases with tight capsule adhesion.

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