Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T16:09:12.483Z Has data issue: false hasContentIssue false

Residual tumour after vestibular schwannoma surgery

Published online by Cambridge University Press:  09 May 2013

C H Hahn*
Affiliation:
Department of Oto-rhino-laryngology, Head and Neck Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark
S E Stangerup
Affiliation:
Department of Oto-rhino-laryngology, Head and Neck Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark Faculty of Health Sciences, University of Copenhagen, Denmark
P Caye-Thomasen
Affiliation:
Department of Oto-rhino-laryngology, Head and Neck Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark Faculty of Health Sciences, University of Copenhagen, Denmark
*
Address for correspondence: Dr Christoffer Holst Hahn, Gjorslevvej 14, 2720 Vanløse, Denmark Fax: +45 39773476 E-mail: christoffer.holst@gmail.com

Abstract

Objective:

To evaluate residual tumour occurrence after vestibular schwannoma surgery, based on intra-operative registration and magnetic resonance imaging one year post-operatively.

Methods:

Patients undergoing translabyrinthine surgery for vestibular schwannoma in Denmark between 1976 and 2008 were registered in a national database covering 5.5 million inhabitants.

Results:

Translabyrinthine surgery was undertaken on 1143 patients. Of these, 978 had total, 140 near-total and 25 subtotal tumour excision, as assessed intra-operatively by the surgeon. One year after surgery, 65 per cent of small tumour remnants and 11 per cent of large tumour remnants were not visible on magnetic resonance imaging. The mean pre-operative size was significantly smaller for totally excised tumours, compared with near-totally and subtotally excised tumours. Revision surgery was performed for 14 patients (1.2 per cent), of whom 2 had received total, 5 near-total and 6 subtotal excisions initially.

Conclusion:

Most residual tumours disappear spontaneously, probably due to devascularisation. Few patients with a small residual vestibular schwannoma will require revision surgery or secondary radiotherapy.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Stangerup, SE, Tos, M, Thomsen, J, Caye-Thomasen, P. True incidence of vestibular schwannoma? Neurosurgery 2010;67:1335–40CrossRefGoogle ScholarPubMed
2Lalwani, AK. Current Diagnosis and Treatment in Otolaryngology Head and Neck Surgery, 2nd edn.New York: McGraw Hill, 2008;765772Google Scholar
3Arriaga, MA, Luxford, WM, Atkins, JS, Kwartler, JA. Predicting long-term facial nerve outcome after acoustic neuroma surgery. Otolaryngol Head Neck Surg 1993;108:220–4CrossRefGoogle ScholarPubMed
4Lownie, SP, Drake, CG. Radical intracapsular removal of acoustic neurinomas. Long-term follow-up review of 11 patients. J Neurosurg 1991;74:422–5CrossRefGoogle ScholarPubMed
5Arlt, F, Trantakis, C, Seifert, V, Bootz, F, Strauss, G, Meixensberger, J. Recurrence rate, time to progression and facial nerve function in microsurgery of vestibular schwannoma. Neurol Res 2011;33:1032–7CrossRefGoogle ScholarPubMed
6Martin, TPC, Fox, H, Ho, E-C, Holder, R, Walsh, R, Irving, RM. Facial nerve outcomes in functional vestibular schwannoma surgery: less than total tumour excision significantly improves results. J Laryngol Otol 2012;126:120–4CrossRefGoogle ScholarPubMed
7Freeman, SRM, Ramsden, RT, Saeed, SR, Alzoubi, FQ, Simo, R, Rutherford, SA et al. Revision surgery for residual or recurrent vestibular schwannoma. Otol Neurotol 2007;28:1076–82CrossRefGoogle ScholarPubMed
8Godefroy, WP, van der Mey, AG, de Bruine, FT, Hoekstra, ER, Malessy, JA. Surgery for large vestibular schwannoma: residual tumor and outcome. Otol Neurotol 2009;30:629–34CrossRefGoogle ScholarPubMed
9Kanzaki, J, Tos, M, Sanna, M, Moffat, D. New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 2003;24:642–8CrossRefGoogle ScholarPubMed
10Sanna, M, Falcioni, M, Taibah, A, Donato, GD, Russo, A, Piccirillo, E. Treatment of residual vestibular schwannoma. Otol Neurotol 2002;23:980–7CrossRefGoogle ScholarPubMed
11Lye, RH, Pace-Balzan, A, Ramsden, RT, Gillespie, JE, Dutton, JM. The fate of tumour rests following removal of acoustic neuromas: an MRI Gd-DTPA study. Br J Neurosurg 1992;6:195201CrossRefGoogle ScholarPubMed
12Donzelli, R, Motta, G, Cavallo, LM, Maiuri, F, De Divitiis, E. One-stage removal of residual intracanalicular acoustic neuroma and hemihypoglossal-intratemporal facial nerve anastomosis: technical note. Neurosurgery 2003;53:1444–7CrossRefGoogle ScholarPubMed
13Cayé-Thomasen, P, Werther, K, Nalla, A, Bøg-Hansen, TC, Nielsen, HJ, Stangerup, S-E et al. VEGF and VEGF receptor-1 concentration in vestibular schwannoma homogenates correlates to tumor growth rate. Otol Neurotol 2005;26:98101CrossRefGoogle ScholarPubMed
14Carlson, ML, Van Abel, KM, Driscoll, CL, Neff, BA, Beatty, CW, Lane, JI et al. Magnetic resonance imaging surveillance following vestibular schwannoma resection. Laryngoscope 2012;122:378–88CrossRefGoogle ScholarPubMed
15Beatty, CW, Ebersold, MJ, Harner, SG. Residual and recurrent acoustic neuromas. Laryngoscope 1987;97:1168–71CrossRefGoogle ScholarPubMed
16Bloch, 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;130:104–12CrossRefGoogle ScholarPubMed
17El-Kashlan, HK, Zeitoun, H, Arts, HA, Hoff, JT, Telian, SA. Recurrence of acoustic neuroma after incomplete resection. Am J Otol 2000;21:389–92CrossRefGoogle ScholarPubMed
18Kemink, 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;104:96–9CrossRefGoogle ScholarPubMed
19Silverstein, H, Rosenberg, SI, Flanzer, JM, Wannamaker, HH, Seidman, MD. An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms. Otolaryngol Head Neck Surg 1993;108:110CrossRefGoogle ScholarPubMed
20Curley, JW, Ramsden, RT, Howell, A, Healy, K, Lye, RH. Oestrogen and progesterone receptors in acoustic neuroma. J Laryngol Otol 1990;104:865–7CrossRefGoogle ScholarPubMed
21Falcioni, M, Fois, P, Taibah, A, Sanna, M. Facial nerve function after vestibular schwannoma surgery. J Neurosurg 2011;115:820–6CrossRefGoogle ScholarPubMed
22Arriaga, MA, Chen, DA. Facial function in hearing preservation acoustic neuroma surgery. Arch Otolaryngol Head Neck Surg 2001;127:543–6CrossRefGoogle ScholarPubMed
23Gjuric, M, Wigand, ME, Wolf, SR. Enlarged middle fossa vestibular schwannoma surgery: experience with 735 cases. Otol Neurotol 2001;22:223–30CrossRefGoogle ScholarPubMed