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Evolving Role of Non-Total Resection in Management of Acoustic Neuroma in the Gamma Knife Era

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, ISSN: 1537-4505, Vol: 41, Issue: 10, Page: e1354-e1359
2020
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Article Description

OBJECTIVE: To examine patients with residual tumor after vestibular schwannoma (VS) resection with focus on need for further therapy, including stereotactic radiosurgery (SRS) and revision surgery. STUDY DESIGN AND SETTING: Retrospective review at two tertiary otology referral centers. PATIENTS AND INTERVENTION: Patients undergoing primary surgery for VS from 2007 to 2017. MAIN OUTCOME MEASURE: Degree of resection and need for further treatment. RESULTS: Of 289 patients undergoing surgery, 38 (13.1%) underwent subtotal resections (<95% of tumor resected) and 77 (26.6%) underwent near-total resections (≥95% but <100%). Patients with any residual tumor had larger tumors preoperatively (mean estimated volume 6.3 cm versus 2.1 cm, p < 0.0005) but were otherwise clinically and demographically similar to the population as a whole. Further treatment (surgery or SRS) was needed in 4.6, 14.3, and 50.0% of patients after gross total, near-total, and subtotal resections, respectively (p < 0.0005). Patients undergoing additional therapy had larger residual tumors (median post- to preoperative estimated volume ratio 0.09 versus 0.01, p < 0.0005). Patients undergoing subtotal and near-total resections had poorer facial function at ultimate follow up than those undergoing gross total resections (p = 0.001), likely due to larger tumors and more difficult resections. Literature review revealed higher rates of gross total resection as well as facial palsy in the pre-SRS era. CONCLUSION: Residual tumor following VS resection is more common today than in the pre-SRS era. Availability of SRS may encourage leaving residual tumor intraoperatively to preserve neural structures. Current surgical strategies decrease surgical morbidity but necessitate further treatment in over 10% of cases.

Bibliographic Details

Luryi, Alexander L; Kveton, John F; Babu, Seilesh; Bojrab, Dennis I; Michaelides, Elias M; Schutt, Christopher A

Ovid Technologies (Wolters Kluwer Health)

Medicine; Neuroscience

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