Jeffrey T Jacob1, Matthew L Carlson2, Colin L Driscoll1,2, Michael J Link1,2. 1. Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A. 2. Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: The primary goals of microsurgery for vestibular schwannoma (VS) include preservation of neural function and complete tumor removal. In a subset of patients, adherent tumor remnant may be intentionally left behind in order to minimize risk of new neurologic deficits. It is not well established if residual tumor volume predicts likelihood of tumor remnant growth. METHODS: Patients with sporadic VS who underwent near-total (NTR) or subtotal (STR) VS resection between 2000 and 2014 were reviewed. Postoperative tumor remnants were volumetrically contoured using T1-weighted gadolinium-enhanced magnetic resonance imaging obtained within 3 months of surgery. RESULTS: A total of 103 patients met study criteria, and the median duration of radiographic follow-up was 41 months (mean 56.1 months, range 12-150 months). Fifty patients underwent NTR and 53 received STR. Overall 14 (13.6%) tumors recurred at a median of 41.0 months. Patients who underwent STR were over 13 times more likely to recur compared with those treated with NTR (hazard ratio 13.31; 95% confidence interval 1.71-103.91; P = 0.014). The median time to recurrence following NTR was 124 months compared to 32 months after STR (P < 0.001). CONCLUSIONS: Long-term follow-up in patients undergoing incomplete resection is essential. Near-total resection has a significantly lower rate of recurrence compared to STR. Maximal surgical resection should be the goal in VS microsurgery. The decision to pursue less than complete resection should be based on intraoperative impression, when it is felt that continued dissection of adherent disease would compromise neurologic outcome. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1877-1882, 2016.
OBJECTIVES/HYPOTHESIS: The primary goals of microsurgery for vestibular schwannoma (VS) include preservation of neural function and complete tumor removal. In a subset of patients, adherent tumor remnant may be intentionally left behind in order to minimize risk of new neurologic deficits. It is not well established if residual tumor volume predicts likelihood of tumor remnant growth. METHODS:Patients with sporadic VS who underwent near-total (NTR) or subtotal (STR) VS resection between 2000 and 2014 were reviewed. Postoperative tumor remnants were volumetrically contoured using T1-weighted gadolinium-enhanced magnetic resonance imaging obtained within 3 months of surgery. RESULTS: A total of 103 patients met study criteria, and the median duration of radiographic follow-up was 41 months (mean 56.1 months, range 12-150 months). Fifty patients underwent NTR and 53 received STR. Overall 14 (13.6%) tumors recurred at a median of 41.0 months. Patients who underwent STR were over 13 times more likely to recur compared with those treated with NTR (hazard ratio 13.31; 95% confidence interval 1.71-103.91; P = 0.014). The median time to recurrence following NTR was 124 months compared to 32 months after STR (P < 0.001). CONCLUSIONS: Long-term follow-up in patients undergoing incomplete resection is essential. Near-total resection has a significantly lower rate of recurrence compared to STR. Maximal surgical resection should be the goal in VS microsurgery. The decision to pursue less than complete resection should be based on intraoperative impression, when it is felt that continued dissection of adherent disease would compromise neurologic outcome. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1877-1882, 2016.
Authors: Christopher S Graffeo; Avital Perry; Aditya Raghunathan; Trynda N Kroneman; Mark Jentoft; Colin L Driscoll; Brian A Neff; Matthew L Carlson; Jeffrey Jacob; Michael J Link; Jamie J Van Gompel Journal: J Neurol Surg B Skull Base Date: 2018-02-07
Authors: Ricky H Wong; William R Copeland; Jeffrey T Jacob; Sananthan Sivakanthan; Jamie J Van Gompel; Harry van Loveren; Michael J Link; Siviero Agazzi Journal: J Neurol Surg B Skull Base Date: 2017-07-25
Authors: Abdullah Egiz; Hritik Nautiyal; Andrew F Alalade; Nihal Gurusinghe; Gareth Roberts Journal: J Neurooncol Date: 2022-06-27 Impact factor: 4.506
Authors: Ben A Strickland; Kristine Ravina; Robert C Rennert; Anna Jackanich; Ksenia Aaron; Joshua Bakhsheshian; Jonathan J Russin; Rick A Friedman; Steven L Giannotta Journal: J Neurol Surg B Skull Base Date: 2019-03-01
Authors: Roland Goldbrunner; Michael Weller; Jean Regis; Morten Lund-Johansen; Pantelis Stavrinou; David Reuss; D Gareth Evans; Florence Lefranc; Kita Sallabanda; Andrea Falini; Patrick Axon; Olivier Sterkers; Laura Fariselli; Wolfgang Wick; Joerg-Christian Tonn Journal: Neuro Oncol Date: 2020-01-11 Impact factor: 12.300
Authors: Giannicola Iannella; Marco de Vincentiis; Cira Di Gioia; Raffaella Carletti; Benedetta Pasquariello; Alessandra Manno; Diletta Angeletti; Ersilia Savastano; Giuseppe Magliulo Journal: J Int Med Res Date: 2017-04-27 Impact factor: 1.671
Authors: Deborah Ruth Smith; Heva Jasmine Saadatmand; Cheng-Chia Wu; Paul J Black; Yen-Ruh Wuu; Jeraldine Lesser; Maryellen Horan; Steven R Isaacson; Tony J C Wang; Michael B Sisti Journal: Neurosurgery Date: 2019-12-01 Impact factor: 4.654
Authors: Mohamed H Khattab; Alexander D Sherry; Nauman Manzoor; Douglas J Totten; Guozhen Luo; Lola B Chambless; Alejandro Rivas; David S Haynes; Anthony J Cmelak; Albert Attia Journal: J Neurol Surg B Skull Base Date: 2020-05-26
Authors: S K Plontke; P Caye-Thomasen; C Strauss; S Kösling; G Götze; U Siebolts; D Vordermark; L Wagner; L Fröhlich; T Rahne Journal: HNO Date: 2021-01 Impact factor: 1.284