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Surgical Treatment of Giant Vestibular Schwannomas: Facial Nerve Outcome and Tumor Control.
- Source :
-
World neurosurgery [World Neurosurg] 2016 Oct; Vol. 94, pp. 137-144. Date of Electronic Publication: 2016 Jul 05. - Publication Year :
- 2016
-
Abstract
- Background: Surgical treatment of giant vestibular schwannomas (GVS) is challenging. The philosophy of incomplete tumor resection may balance the preservation of facial nerve function and long-term tumor control.<br />Objective: We aimed to evaluate the outcome of facial nerve function and tumor control in treating GVS via our institutional surgical strategy.<br />Methods: From September 2009 to August 2014, 218 patients who underwent surgical treatment of GVS were enrolled in our study. The clinical features, extent of resections, facial nerve outcome, and the tumor regrowth free rate of these patients were retrospectively analyzed. The treatment strategy of this disease was discussed.<br />Results: All patients had anatomic preservation of the facial nerve. Gross total resection (GTR) was achieved in 58 patients (28.6%), near-total resection (NTR) in 103 (50.7%), and subtotal resection (STR) in 42 (20.7%). Two patients died because of postoperative complications. After a mean follow-up of 39.7 ± 18.3 months, a favorable facial nerve outcome was achieved in 58.6%, 79.6%, and 83.3% of patients who underwent GTR, NTR, and STR, respectively. During follow-up, 20 patients had tumor regrowth and were treated by stereotactic radiosurgery (SRS), and tumor regrowth free rates were 96.6%, 92.2%, and 76.2% in GTR, NTR, and STR, respectively. The extent of resection was the independent risk factor for poor facial nerve function (P = 0.006).<br />Conclusions: A surgical philosophy of prioritizing facial nerve preservation over total tumor resection was recommended in treatment of GVS. Favorable facial nerve outcome and tumor control were achieved after NTR of the tumors.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Facial Nerve Injuries etiology
Female
Follow-Up Studies
Humans
Male
Microsurgery adverse effects
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local radiotherapy
Neoplasm, Residual
Neuroma, Acoustic pathology
Neurosurgical Procedures adverse effects
Organ Sparing Treatments
Postoperative Complications epidemiology
Radiosurgery
Regression Analysis
Retrospective Studies
Tumor Burden
Young Adult
Facial Nerve
Microsurgery methods
Neoplasm Recurrence, Local epidemiology
Neuroma, Acoustic surgery
Neurosurgical Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 1878-8769
- Volume :
- 94
- Database :
- MEDLINE
- Journal :
- World neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 27392890
- Full Text :
- https://doi.org/10.1016/j.wneu.2016.06.119