Subscribe to RSS
DOI: 10.1055/s-0041-1725028
Facial Nerve Function Outcome and Risk Factors in Resection of Large Cystic Vestibular Schwannomas
![](https://www.thieme-connect.de/media/jnlsb/2022S02/lookinside/thumbnails/10-1055-s-0041-1725028_200256-1.jpg)
Abstract
Objective Cystic vestibular schwannomas (VS) in contrast to solid VS tend to have accelerated growth, larger volume, rapid/atypical presentation, lobulated/adherent surface, and unpredictable course of the cranial nerves. Cystic VS are surgically challenging, with worse clinical outcomes and higher rate of subtotal resection (STR).
Methods We retrospectively analyzed postoperative outcomes of 125 patients with cystic VS, operated between years 2005 and 2019 in our center. We confronted the extent of the resection and House-Brackmann (HB) grade of facial palsy with the results of comparable cohort of patients with solid VS operated in our center and literature review by Thakur et al.1
Results Translabyrinthine approach was preferred for resection of large, cystic VS (97.6%). Gross-total resection (GTR) was achieved in 78 patients (62.4%), near-total resection (NTR) with remnant (<4 × 4 × 2 mm) in 43 patients (34.4%), and STR in 4 patients (3.2%). NTR/STR were significantly associated with higher age, tumor volume >5 cm3, retrosigmoid approach, high-riding jugular bulb, tumor adherence to the brain stem, and facial nerve (p = 0.016; 0.003; 0.005; 0.025; 0.001; and <0.00001, respectively).
One year after the surgery, 76% of patients had HB grades 1 to 2, 16% had HB grades 3 to 4, and 8% had HB grades 5 to 6 palsy. Worse outcome (HB grades 3 to 6) was associated with preoperative facial palsy, tumor volume >25 cm3, and cyst over the brain stem (p = 0.045; 0.014; and 0.05, respectively). Comparable solid VS operated in our center had significantly higher HB grades 1 to 2 rate than our cystic VS (94% versus 76%; p = 0.03). Comparing our results with literature review, our HB grades 1 to 2 rate was significantly higher (76% versus 39%; p = 0.0001). Tumor control rate 5 years after surgery was 95.8%.
Conclusion Our study confirmed that microsurgery of cystic VS has worse outcomes of facial nerve preservation and extent of resection compared with solid VS. Greater attention should be paid to the above-mentioned risk factors.
Keywords
cystic vestibular schwannoma - microsurgery - facial nerve outcome - near-total resection - long-term outcomePublication History
Received: 13 July 2020
Accepted: 30 December 2020
Article published online:
01 March 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Thakur JD, Khan IS, Shorter CD. et al. Do cystic vestibular schwannomas have worse surgical outcomes? Systematic analysis of the literature. Neurosurg Focus 2012; 33 (03) E12
- 2 Charabi S, Tos M, Børgesen SE, Thomsen J. Cystic acoustic neuromas. Results of translabyrinthine surgery. Arch Otolaryngol Head Neck Surg 1994; 120 (12) 1333-1338
- 3 Kameyama S, Tanaka R, Kawaguchi T, Fukuda M, Oyanagi K. Cystic acoustic neurinomas: studies of 14 cases. Acta Neurochir (Wien) 1996; 138 (06) 695-699
- 4 Pendl G, Ganz JC, Kitz K, Eustacchio S. Acoustic neurinomas with macrocysts treated with Gamma Knife radiosurgery. Stereotact Funct Neurosurg 1996; 66 (Suppl. 01) 103-111
- 5 Tali ET, Yuh WTC, Nguyen HD. et al. Cystic acoustic schwannomas: MR characteristics. AJNR Am J Neuroradiol 1993; 14 (05) 1241-1247
- 6 Benech F, Perez R, Fontanella MM, Morra B, Albera R, Ducati A. Cystic versus solid vestibular schwannomas: a series of 80 grade III-IV patients. Neurosurg Rev 2005; 28 (03) 209-213
- 7 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997; 40 (01) 11-21 , discussion 21–23
- 8 Piccirillo E, Wiet MR, Flanagan S. et al. Cystic vestibular schwannoma: classification, management, and facial nerve outcomes. Otol Neurotol 2009; 30 (06) 826-834
- 9 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
- 10 Tysome JR, Moffat DA. Magnetic resonance imaging after translabyrinthine complete excision of vestibular schwannomas. J Neurol Surg B Skull Base 2012; 73 (02) 121-124
- 11 Hardy DG, Macfarlane R, Baguley D, Moffat DA. Surgery for acoustic neurinoma. An analysis of 100 translabyrinthine operations. J Neurosurg 1989; 71 (06) 799-804
- 12 Fundová P, Charabi S, Tos M, Thomsen J. Cystic vestibular schwannoma: surgical outcome. J Laryngol Otol 2000; 114 (12) 935-939
- 13 Moon KS, Jung S, Seo SK. et al. Cystic vestibular schwannomas: a possible role of matrix metalloproteinase-2 in cyst development and unfavorable surgical outcome. J Neurosurg 2007; 106 (05) 866-871
- 14 Park CK, Kim DC, Park SH. et al. Microhemorrhage, a possible mechanism for cyst formation in vestibular schwannomas. J Neurosurg 2006; 105 (04) 576-580
- 15 Mehrotra N, Behari S, Pal L, Banerji D, Sahu RN, Jain VK. Giant vestibular schwannomas: focusing on the differences between the solid and the cystic variants. Br J Neurosurg 2008; 22 (04) 550-556
- 16 Jian BJ, Sughrue ME, Kaur R. et al. Implications of cystic features in vestibular schwannomas of patients undergoing microsurgical resection. Neurosurgery 2011; 68 (04) 874-880 , discussion 879–880
- 17 Moffat DA, Quaranta N, Chang P. Management of the high jugular bulb in translabyrinthine surgery. Laryngoscope 2003; 113 (03) 580-582
- 18 Nakatomi H, Jacob JT, Carlson ML. et al. Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma. J Neurosurg 2017; 19: 1-7
- 19 Iannella G, de Vincentiis M, Di Gioia C. et al. Subtotal resection of vestibular schwannoma: evaluation with Ki-67 measurement, magnetic resonance imaging, and long-term observation. J Int Med Res 2017; 45 (03) 1061-1073
- 20 Monfared A, Corrales CE, Theodosopoulos PV. et al. Facial nerve outcome and tumor control rate as a function of degree of resection in treatment of large acoustic neuromas: preliminary report of the Acoustic Neuroma Subtotal Resection Study (ANSRS). Neurosurgery 2016; 79 (02) 194-203
- 21 Sughrue ME, Kaur R, Rutkowski MJ. et al. Extent of resection and the long-term durability of vestibular schwannoma surgery. J Neurosurg 2011; 114 (05) 1218-1223
- 22 Schwartz MS, Kari E, Strickland BM. et al. Evaluation of the increased use of partial resection of large vestibular schwanommas: facial nerve outcomes and recurrence/regrowth rates. Otol Neurotol 2013; 34 (08) 1456-1464
- 23 Sampath P, Rini D, Long DM. Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases. J Neurosurg 2000; 92 (01) 70-78
- 24 Mastronardi L, Cacciotti G, Roperto R, Di Scipio E, Tonelli MP, Carpineta E. Position and course of facial nerve and postoperative facial nerve results in vestibular schwannoma microsurgery. World Neurosurg 2016; 94: 174-180
- 25 Frisch CD, Jacob JT, Carlson ML. et al. Stereotactic radiosurgery for cystic vestibular schwannomas. Neurosurgery 2017; 80 (01) 112-118
- 26 Bowden G, Cavaleri J, Monaco III E, Niranjan A, Flickinger J, Lunsford LD. Cystic vestibular schwannomas respond best to radiosurgery. Neurosurgery 2017; 81 (03) 490-497