Download PDF
J Neurol Surg B Skull Base 2018; 79(04): 319-324
DOI: 10.1055/s-0037-1607421
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Growth Patterns of Residual Tumor in Preoperatively Growing Vestibular Schwannomas

Anand V. Kasbekar
1   Department of Otorhinolaryngology, Head & Neck Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
,
Guleed H. Adan
2   Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospitals, Liverpool, United Kingdom
,
Alaina Beacall
2   Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospitals, Liverpool, United Kingdom
,
Ahmed M. Youssef
2   Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospitals, Liverpool, United Kingdom
3   Department of ENT, Ain Shams University, Cairo, Egypt
,
Catherine E. Gilkes
4   Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom
,
Tristram H. Lesser
2   Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospitals, Liverpool, United Kingdom
› Author Affiliations Funding This research received no specific grant from any funding agency or commercial or not-for-profit sectors.
Further Information

Publication History

03 February 2017

15 September 2017

Publication Date:
08 November 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objectives To analyze growth of residual vestibular schwannoma (VS) following incomplete tumor resection and determine the influence of residual location and size.

Design Retrospective case note and scan review.

Setting Tertiary skull base unit.

Participants Patients with residual tumor following primary surgery for medium and large unilateral growing vestibular schwanomas between 2006 and 2009.

Main Outcome Measures Location of residual VS and post-operative growth, comparing those with more (>5%) or less than 5% of tumor residual (<5%).

Results Fifty-two patients had visible residual tumor left behind at surgery. Twenty had < 5% and 32 had > 5% residual. The residual growth rates were 38% overall, 20% in < 5%, and 50% in > 5% residuals. There was no significant difference in growth rates at different residual locations. Median follow-up was 6.4 years.

Conclusions There is a greater risk of regrowth of residuals > 5%. All positions of residual tumor can regrow, and the preoperative tumor size plays a role in this. Further data is needed to confirm if residual tumor in the fundus is less likely to grow.

Keywords

vestibular schwannoma - residual tumor - tumor regrowth

Note

This article was presented orally at the British Skull Base Society Meeting, January 29–30, 2015, Dublin, Ireland.


 

  • References

  • 1 Reddy CE, Lewis-Jones HG, Javadpour M, Ryland I, Lesser TH. Conservative management of vestibular schwannomas of 15 to 31 mm intracranial diameter. J Laryngol Otol 2014; 128 (09) 752-758
    CrossrefPubMedGoogle Scholar
  • 2 Ellenbogen JR, Waqar M, Kinshuck AJ. , et al. Linear accelerator radiosurgery for vestibular schwannomas: results of medium-term follow-up. Br J Neurosurg 2015; 29 (05) 678-684
    CrossrefPubMedGoogle Scholar
  • 3 Leong SC, Lesser TH. A United Kingdom survey of concerns, needs, and priorities reported by patients diagnosed with acoustic neuroma. Otol Neurotol 2015; 36 (03) 486-490
    CrossrefPubMedGoogle Scholar
  • 4 Khrais T, Sanna M. Hearing preservation surgery in vestibular schwannoma. J Laryngol Otol 2006; 120 (05) 366-370
    CrossrefPubMedGoogle Scholar
  • 5 Sughrue ME, Yang I, Rutkowski MJ, Aranda D, Parsa AT. Preservation of facial nerve function after resection of vestibular schwannoma. Br J Neurosurg 2010; 24 (06) 666-671
    CrossrefPubMedGoogle Scholar
  • 6 Leong SC, Lesser TH. A national survey of facial paralysis on the quality of life of patients with acoustic neuroma. Otol Neurotol 2015; 36 (03) 503-509
    CrossrefPubMedGoogle Scholar
  • 7 Rosenberg SI. Natural history of acoustic neuromas. Laryngoscope 2000; 110 (04) 497-508
    CrossrefPubMedGoogle Scholar
  • 8 Raut VV, Walsh RM, Bath AP. , et al. Conservative management of vestibular schwannomas - second review of a prospective longitudinal study. Clin Otolaryngol Allied Sci 2004; 29 (05) 505-514
    CrossrefPubMedGoogle Scholar
  • 9 Hahn CH, Stangerup SE, Caye-Thomasen P. Residual tumour after vestibular schwannoma surgery. J Laryngol Otol 2013; 127 (06) 568-573
    CrossrefPubMedGoogle Scholar
  • 10 Bloch DC, Oghalai JS, Jackler RK, Osofsky M, Pitts LH. The fate of the tumor remnant after less-than-complete acoustic neuroma resection. Otolaryngol Head Neck Surg 2004; 130 (01) 104-112
    CrossrefPubMedGoogle Scholar
  • 11 Chen Z, Prasad SC, Di Lella F. , et al. The behavior of residual tumors and facial nerve outcomes after incomplete excision of vestibular schwannomas. J Neurosurg 2014; 120 (06) 1278-1287
    CrossrefPubMedGoogle Scholar
  • 12 Kameyama S, Tanaka R, Kawaguchi T, Honda Y, Yamazaki H, Hasegawa A. Long-term follow-up of the residual intracanalicular tumours after subtotal removal of acoustic neurinomas. Acta Neurochir (Wien) 1996; 138 (02) 206-209
    CrossrefPubMedGoogle Scholar
  • 13 Zhao X, Wang Z, Ji Y. , et al. Long-term facial nerve function evaluation following surgery for large acoustic neuromas via retrosigmoid transmeatal approach. Acta Neurochir (Wien) 2010; 152 (10) 1647-1652
    CrossrefPubMedGoogle Scholar
  • 14 Lalwani AK, Butt FY, Jackler RK, Pitts LH, Yingling CD. Facial nerve outcome after acoustic neuroma surgery: a study from the era of cranial nerve monitoring. Otolaryngol Head Neck Surg 1994; 111 (05) 561-570
    CrossrefPubMedGoogle Scholar
  • 15 Angeli RD, Piccirillo E, Di Trapani G, Sequino G, Taibah A, Sanna M. Enlarged translabyrinthine approach with transapical extension in the management of giant vestibular schwannomas: personal experience and review of literature. Otol Neurotol 2011; 32 (01) 125-131
    CrossrefPubMedGoogle Scholar
  • 16 Godefroy WP, van der Mey AG, de Bruine FT, Hoekstra ER, Malessy MJ. Surgery for large vestibular schwannoma: residual tumor and outcome. Otol Neurotol 2009; 30 (05) 629-634
    CrossrefPubMedGoogle Scholar
  • 17 Kanzaki J, Tos M, Sanna M, Moffat DA, Monsell EM, Berliner KI. New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003; 24 (04) 642-648 ; discussion 648–649
    CrossrefPubMedGoogle Scholar
  • 18 Weissman JL, Hirsch BE, Fukui MB, Rudy TE. The evolving MR appearance of structures in the internal auditory canal after removal of an acoustic neuroma. AJNR Am J Neuroradiol 1997; 18 (02) 313-323
    PubMedGoogle Scholar
  • 19 Carlson ML, Van Abel KM, Driscoll CL. , et al. Magnetic resonance imaging surveillance following vestibular schwannoma resection. Laryngoscope 2012; 122 (02) 378-388
    CrossrefPubMedGoogle Scholar
  • 20 Spielmann PM, Sillars H. Assessing the threshold for vestibular schwannoma resection and the behavior of residual tumor. Otol Neurotol 2013; 34 (05) 935-938
    CrossrefPubMedGoogle Scholar
  • 21 Arriaga MA, Luxford WM, Atkins Jr JS, Kwartler JA. Predicting long-term facial nerve outcome after acoustic neuroma surgery. Otolaryngol Head Neck Surg 1993; 108 (03) 220-224
    CrossrefPubMedGoogle Scholar
  • 22 Kemink JL, Langman AW, Niparko JK, Graham MD. Operative management of acoustic neuromas: the priority of neurologic function over complete resection. Otolaryngol Head Neck Surg 1991; 104 (01) 96-99
    CrossrefPubMedGoogle Scholar
  • 23 Silverstein H, McDaniel A, Norrell H, Wazen J. Conservative management of acoustic neuroma in the elderly patient. Laryngoscope 1985; 95 (7 Pt 1): 766-770
    PubMedGoogle Scholar
  • 24 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
    CrossrefPubMedGoogle Scholar
  • 25 El-Kashlan HK, Zeitoun H, Arts HA, Hoff JT, Telian SA. Recurrence of acoustic neuroma after incomplete resection. Am J Otol 2000; 21 (03) 389-392
    Google Scholar
  • 26 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
    CrossrefPubMedGoogle Scholar
  • 27 Nedzelski JM, Canter RJ, Kassel EE, Rowed DW, Tator CH. Is no treatment good treatment in the management of acoustic neuromas in the elderly?. Laryngoscope 1986; 96 (08) 825-829
    CrossrefPubMedGoogle Scholar
  • 28 Schulder M, Jacobs A, Carmel PW. Intraoperative MRI and adjuvant radiosurgery. Stereotact Funct Neurosurg 2001; 76 (3–4): 151-158
    CrossrefPubMedGoogle Scholar