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DOI: 10.1055/s-0034-1384160
Feasibility of Near-Total Extirpation of Vestibular Schwannoma with Salvage Radiosurgery
Objective: To determine the feasibility of near-total removal of large-size vestibular schwannoma (VS), with salvage radiosurgery (SRS) in case of documented growth of the remnant. Study Design: Retrospective cohort study. Methods: Between 2005 and 2011, 55 patients had a retrosigmoid craniotomy with (near-total) removal of large-size VS. SRS was only instituted following growth of the remnant on follow-up MRI. Prognostic factors for growth of the remnant were studied using multiple logistic regression analysis. Postoperative facial nerve functioning was documented. Results: In 45 patients (81.8%) a small remnant was left after surgery, while in 10 (18.2%) patients total resection was achieved. The mean preoperative tumor volume was 12.15 cm3 (SD 9.23); the mean volume of the remnant was 0.22 cm3 (SD 0.34). The mean postoperative follow-up time was 35.4 months (SD 21.10). Salvage SRS was deemed necessary in seven patients (12.7%). The size of the postoperative tumor remnant was a significant predictor for the necessity of postoperative adjuvant SRS. Normal facial nerve function (HB 1) was preserved in 31 patients (56.4%), while 17 patients (30.9%) experienced a permanent mild facial nerve deficit (HB 2, 3) and 5 patients (9.1%) experienced a severe facial nerve deficit (HB grade 4-6). Conclusion: Initial observation after near-total surgical removal of large-size VS appears to be a feasible strategy, with only a minority of patients requiring salvage radiosurgery during follow-up.