Rabih Aboukaïs1, Nicolas-Xavier Bonne2, Gustavo Touzet3, Christophe Vincent4, Nicolas Reyns5, Jean-Paul Lejeune6. 1. Department of Neurosurgery, CHU Lille, University of Lille, France. Electronic address: rabih.aboukais@chru-lille.fr. 2. Department of Otology, CHU Lille, University of Lille, France. Electronic address: nicolas-xavier.bonne@chru-lille.fr. 3. Department of Neurosurgery, CHU Lille, University of Lille, France. Electronic address: gustavo.touzet@chru-lille.fr. 4. Department of Otology, CHU Lille, University of Lille, France. Electronic address: christophe.vincent@chru-lille.fr. 5. Department of Neurosurgery, CHU Lille, University of Lille, France. Electronic address: nicolas.reyns@chru-lille.fr. 6. Department of Neurosurgery, CHU Lille, University of Lille, France. Electronic address: jean-paul.lejeune@chru-lille.fr.
Abstract
OBJECTIVE: We aimed to evaluate the outcome of patients who underwent salvage microsurgery for vestibular schwannoma (VS) that failed primary Gammaknife radiosurgery (GKS). PATIENTS AND METHODS: Among the 1098 patients who received GKS for the treatment of VS in our center between January 2004 and December 2012, the follow-up was organized in our institution for 290 patients who lived in our recruitment area. Tumor progression was noted in 23 patients. A salvage microsurgical resection was performed in 11 patients, who were included in our study. Grading of facial function was done according to the House & Brackman scale. RESULTS: The mean age at diagnosis was 50.2 years (19-68 years) and the mean follow-up was 9.4 years (4-13 years). The mean dose was 11.8 Gy (11-12 Gy) and the mean volume was 922 mm3 (208-2500 mm3). The mean period between GKS and diagnosis of tumor progression was 32 months (18-72 months). Concerning salvage microsurgery, complete resection was obtained in 8 patients. Small residual tumor on the facial nerve was deliberately left in 3 patients and no tumor progression was noted with a mean follow-up of 26 months. At last follow-up, facial nerve function was grade 1 in 4 patients, grade 2 in 3 patients, grade 3 in 1 patient and grade 4 in 3 patients. CONCLUSION: Salvage surgery of recurrent vestibular schwannoma after failed initial GKS remains a good treatment. However, facial nerve preservation is more challenging in this case and small tumor remnant could be sometimes deliberately left.
OBJECTIVE: We aimed to evaluate the outcome of patients who underwent salvage microsurgery for vestibular schwannoma (VS) that failed primary Gammaknife radiosurgery (GKS). PATIENTS AND METHODS: Among the 1098 patients who received GKS for the treatment of VS in our center between January 2004 and December 2012, the follow-up was organized in our institution for 290 patients who lived in our recruitment area. Tumor progression was noted in 23 patients. A salvage microsurgical resection was performed in 11 patients, who were included in our study. Grading of facial function was done according to the House & Brackman scale. RESULTS: The mean age at diagnosis was 50.2 years (19-68 years) and the mean follow-up was 9.4 years (4-13 years). The mean dose was 11.8 Gy (11-12 Gy) and the mean volume was 922 mm3 (208-2500 mm3). The mean period between GKS and diagnosis of tumor progression was 32 months (18-72 months). Concerning salvage microsurgery, complete resection was obtained in 8 patients. Small residual tumor on the facial nerve was deliberately left in 3 patients and no tumor progression was noted with a mean follow-up of 26 months. At last follow-up, facial nerve function was grade 1 in 4 patients, grade 2 in 3 patients, grade 3 in 1 patient and grade 4 in 3 patients. CONCLUSION: Salvage surgery of recurrent vestibular schwannoma after failed initial GKS remains a good treatment. However, facial nerve preservation is more challenging in this case and small tumor remnant could be sometimes deliberately left.
Authors: Won Jae Lee; Jung Il Lee; Jung Won Choi; Doo Sik Kong; Do Hyun Nam; Yang Sun Cho; Hyung Jin Shin; Ho Jun Seol Journal: J Korean Med Sci Date: 2021-04-26 Impact factor: 2.153