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J Neurol Surg A Cent Eur Neurosurg 2022; 83(01): 039-045
DOI: 10.1055/s-0041-1725951
Original Article

Volumetry and Surgical Grading Systems for Vestibular Schwannoma Size Assessment and their Relationship to Postoperative Facial Nerve Function

Catharina Strauss‡   *
1   Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
,
Stefan Rampp‡   *
2   Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
,
Christian Scheller
3   Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany
,
Julian Prell
2   Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
,
Christian Strauss
2   Department of Neurosurgery, University Hospital Halle (Saale), Halle (Saale), Germany
,
Arnd Doerfler
1   Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
,
Tobias Engelhorn
1   Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
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Abstract

Background and Study Aims Treatment modalities in vestibular schwannoma (VS) are difficult to compare since different techniques for size measurements are used. The purpose of this study was to evaluate the relation between different tumor size grading systems regarding their compatibility as well as the relationship to facial nerve outcome facilitating comparisons of different studies.

Material and Methods In this retrospective study, preoperative magnetic resonance imaging of 100 patients with surgically treated VS was evaluated regarding total tumor volume and anatomical extension based on the Koos and Samii classification, as well as volumetric and maximal diameter measures. Three-dimensional constructive interference in steady state (3D-CISS) and T1 postcontrast volumetric interpolated breath-hold examination (VIBE) sequences were used. Facial nerve function was evaluated according to the House–Brackmann (HB) scale 6 months following complete tumor removal via the retrosigmoid approach.

Results Tumor size showed a moderate influence on postsurgical facial nerve function with correlations not exceeding 0.4. Severe palsy was observed mainly in patients with large tumors with Koos grade 4, Samii grade 4b, respectively a volume of at least 6 cm3 or a maximum diameter of 2.4 cm for HB ≥ 3 and a volume of 7.5 cm3 and maximum diameter of 3.2 cm for HB ≥ 4. In regard to volumetry, the Koos and Samii grading systems were highly comparable, whereas the maximal diameter showed consistently lower correlation values.

Conclusions The results of our study allow direct comparison of studies on surgery versus radiotherapy of VS. The data allow for translation of tumor sizes based on different grading systems. Comparison of microsurgical, radiotherapeutic and radiosurgical approaches should concentrate on patients with large tumors. Whereas smaller tumors were rarely associated with severe facial palsy, large tumors did not exclude the possibility of weak or no palsy 6 months after surgery.

Keywords

vestibular schwannoma - volumetry - Koos classification - facial nerve outcome risk analysis - surgery

* These authors contributed equally to the article.




Publication History

Received: 05 May 2020

Accepted: 26 November 2020

Article published online:
07 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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