41 Subtotal Resection of Sporadic Vestibular Schwannoma

2019 ◽  
Keyword(s):  
Vestibular Schwannoma ◽  
Subtotal Resection

scholarly journals Microsurgical Gross Total Resection of a Large Residual/Recurrent Vestibular Schwannoma via Translabyrinthine Approach

2018 ◽  
Vol 79 (S 05) ◽  
pp. S387-S388
Author(s):  
Sima Sayyahmelli ◽  
Joseph Roche ◽  
Mustafa Baskaya
Keyword(s):  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Entry Zone ◽  
Stereotactic Radiation ◽  
Translabyrinthine Approach ◽  
History Of ◽  
Microsurgical Techniques ◽  
Facial Function

Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a translabyrinthine approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed.The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw.

scholarly journals Surgeon-Planned Subtotal Resection of Vestibular Schwannoma Diverges from the Optimal Radiosurgical Target Defined by Adaptive Hybrid Surgery Software

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
John Sheppard ◽  
Carlito Lagman ◽  
Thien Nguyen ◽  
Yasmine Alkhalid ◽  
Courtney Duong ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Subtotal Resection ◽  
Hybrid Surgery

scholarly journals Autonomic Cross-Innervation in Patients With Neurofibromatosis Type 2: Frey Syndrome and Unilateral Epiphora With Rhinorrhea

2019 ◽  
Vol 6 ◽  
pp. 2329048X1986661
Author(s):  
Erica Evans ◽  
David Nascene ◽  
Katherine Sommer ◽  
Christopher Moertel
Keyword(s):  
Heat Stress ◽  
Vestibular Schwannoma ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Subtotal Resection ◽  
First Case ◽  
Iodine Test

The authors present 2 cases of cross-innervation in patients with neurofibromatosis type 2. In the first case, an iodine test was performed to demonstrate Frey syndrome in a 28-year-old female with neurofibromatosis type 2 who developed symptoms at age 10 years. The second patient is an 18-year-old female with neurofibromatosis type 2, 2 years status post left vestibular schwannoma subtotal resection who presented with paradoxical unilateral lacrimation and rhinorrhea triggered by heat stress and exercise. The pathophysiology of these cases is discussed.

Planned Subtotal Resection of Vestibular Schwannoma Differs from the Ideal Radiosurgical Target Defined by Adaptive Hybrid Surgery

2018 ◽  
Vol 114 ◽  
pp. e441-e446 ◽  
Author(s):  
John P. Sheppard ◽  
Carlito Lagman ◽  
Giyarpuram N. Prashant ◽  
Yasmine Alkhalid ◽  
Thien Nguyen ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Subtotal Resection ◽  
Hybrid Surgery ◽  
The Ideal

Unplanned Subtotal Resection of Vestibular Schwannoma

Skull Base ◽  
2011 ◽  
Vol 21 (S 01) ◽  
Author(s):  
Albert Tu ◽  
Ryojo Akagami
Keyword(s):  
Vestibular Schwannoma ◽  
Subtotal Resection

scholarly journals Macrophage Density Predicts Facial Nerve Outcome and Tumor Growth after Subtotal Resection of Vestibular Schwannoma

2018 ◽  
Vol 79 (05) ◽  
pp. 482-488
Author(s):  
Christopher Graffeo ◽  
Avital Perry ◽  
Aditya Raghunathan ◽  
Trynda Kroneman ◽  
Mark Jentoft ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Facial Nerve ◽  
Tumor Progression ◽  
Vestibular Schwannoma ◽  
Subtotal Resection ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Macrophage Density ◽  
Primary Endpoints ◽  
Percent Positivity

Introduction Vestibular schwannoma (VS) behavior following subtotal resection (STR) is highly variable. Overall progression rates have been reported as high as 44%, and optimal treatment is controversial. Correspondingly, identification of a reliable clinical or pathologic marker associated with progression after STR would help guide decision-making. Methods A prospectively maintained institutional VS registry from 1999 to 2014 was retrospectively reviewed for sporadic VS patients who underwent primary STR without preceding stereotactic radiosurgery (SRS) by a single neurosurgery-neurotology team. Primary endpoints included tumor progression and postoperative facial nerve function. Pathologic specimens were stained for Ki67, CD68, S100, and SOX10 and were quantitated by digital imaging analysis. Macrophage density was defined as the ratio of CD68+ macrophages to S100+ macrophages and Schwannian tumor cells. Clinical outcomes were correlated with pathologic markers. Results Forty-six patients met the study inclusion criteria. Thirteen (28%) progressed during a mean 57 months of follow-up (range 15–149). Favorable postoperative facial nerve function (House–Brackmann I–II) was achieved in 37 (80%). CD68+ cells were present at significantly higher concentrations in tumors that progressed (p = 0.03). Higher macrophage density was significantly associated with both tumor progression (p = 0.02) and unfavorable facial nerve function (p = 0.02). Ki67 percent positivity was not significantly associated with either primary endpoint (p = 0.83; p = 0.58). Conclusions Macrophage density may provide an important marker for individuals at the highest risk for progression of VS after STR, potentially prompting closer surveillance or consideration for upfront SRS following STR. This finding supports preceding conclusions that an intratumoral macrophage-predominant inflammatory response may be a marker for tumor growth and a potential therapeutic target.

Outcomes in Patients with Vestibular Schwannoma after Subtotal Resection and Adjuvant Radiosurgery

2016 ◽  
Vol 94 (4) ◽  
pp. 216-224 ◽  
Author(s):  
Hesham Radwan ◽  
Mark Bruce Eisenberg ◽  
Jonathan Petrus Sandberg Knisely ◽  
Maged Mofied Ghaly ◽  
Michael Schulder
Keyword(s):  
Vestibular Schwannoma ◽  
Subtotal Resection

scholarly journals An Evidence-Based Vestibular Schwannoma Surgical Outcome Grading Scale for Large-to-Giant Vestibular Schwannomas

2021 ◽  
Author(s):  
Nida Fatima ◽  
Gregory P. Lekovic
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Grading System ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Mesh Terms ◽  
Large Vestibular Schwannoma

Abstract Objectives: The objective of this study was to determine the relationship between facial nerve function and extent of resection (EOR) as outcomes in the surgical management of large vestibular schwannoma (VS) (≥ 2.5 cm maximal) and evaluate use of a new grading system that incorporates both outcomes.Methods: We conducted a systematic review of the electronic databases using different MeSH terms from 1990 to 2021. 5,623 patients from 56 studies were found appropriate for inclusion in the study. Surgical approach was reported in 5,144 patients, including translabyrinthine approach (TL) in 43.3% (n=2,225), retrosigmoid (RS) approach in 56.3% (n=2,899), retrolabyrinthine (RL) approach in 0.3% (n=16), and extended translabyrinthine (EX) approach in 0.1% (n=4). The proposed VS Grading System defines outcomes of gross total resection (GTR), near total resection (NTR) and subtotal resection (STR) with good facial nerve function [House-Brackmann (HB) Grade I-II] as Classes A, B and C respectively. Those with poor facial nerve outcome (HB III-VI) are graded as Classes D, E and F, respectively. Results:. As expected, patients with STR had a higher likelihood of better facial nerve outcomes (HB I-II) compared to NTR [Odds Ratio (OR): 7.30, 95%CI: 2.45-12.1, p=0.004] and GTR (OR: 9.61, 95%CI: 3.61-15.6, p=0.002), while NTR had better facial nerve outcome than GTR (OR: 1.5, 95%CI: 1.14-4.6, p<0.0001). A Class A result, representing the best possible outcome, was obtained in 55.8% of TL vs. 49.4% undergoing RS approach. Conclusion: Complete surgical resection with preservation of facial nerve function is the gold standard for large VS.

scholarly journals Subtotal resection of vestibular schwannoma: Evaluation with Ki-67 measurement, magnetic resonance imaging, and long-term observation

2017 ◽  
Vol 45 (3) ◽  
pp. 1061-1073 ◽  
Author(s):  
Giannicola Iannella ◽  
Marco de Vincentiis ◽  
Cira Di Gioia ◽  
Raffaella Carletti ◽  
Benedetta Pasquariello ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Immunohistochemical Analysis ◽  
Vestibular Schwannomas ◽  
Subtotal Resection ◽  
Ki 67 ◽  
Radiological Data ◽  
Tumor Regrowth ◽  
Clinically Significant ◽  
Long Term Observation

Purpose The aim of this study was to compare the postoperative clinical and radiological data of patients with vestibular schwannomas who were initially managed by near total resection (NTR) or subtotal resection (STR). The Ki-67 analysis results were compared with tumor regrowth to determine the presence of a correlation between this proliferative index and postoperative tumor regrowth. Study Design Seventeen adult patients (7 male, 10 female) were retrospectively reviewed. Nine (52.9%) and eight (47.1%) patients underwent NTR and STR, respectively. Postoperative clinical and radiological data associated with vestibular schwannoma growth were compared with the Ki-67 immunohistochemical analysis results. Results Evidence of clinically significant regrowth was observed in four (23.5%) patients. Patients who underwent NTR had a lower rate/incidence of tumor regrowth than did patients who underwent STR. Patients with a higher Ki-67 index had the highest tumor regrowth rates. Conclusions Our study indicates that assessment of the Ki-67 index may be useful for determining the probability of regrowth of vestibular schwannomas when only partial removal is accomplished.

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