scholarly journals Fate of Residual Tumor After Subtotal-resected, Previously-irradiated Vestibular Schwannoma: Long-term Follow-up of a Single Institutional Series

2021 ◽  
Author(s):  
Joonho Byun ◽  
Sang Woo Song ◽  
Young-Hoon Kim ◽  
Chang Ki Hong ◽  
Jeong Hoon Kim
Keyword(s):  
Vestibular Schwannoma ◽  
Salvage Surgery ◽  
Residual Tumor ◽  
Cyst Formation ◽  
Subtotal Resection ◽  
Total Resection ◽  
Salvage Resection ◽  
Long Term Follow Up ◽  
History Of

Abstract Background: The fate of residual tumor after salvage surgery for recurrent vestibular schwannoma (VS) after radiosurgery has not been elucidated. We reviewed our surgical series of salvage surgery for recurrent VS and the natural history of the residual tumor after salvage surgery.Methods: This study enrolled 14 patients who were received salvage surgical resection in our institute and were followed-up for >12 months.Results: There were 3 male and 11 female patients with a median age of 55 years (range: 16-70). The pre-SRS tumor volume was a median 6591 mm3. All patients were treated by GKS. The median duration from GKS to surgery was 52 months (range: 10-116). Solid tumor growth was observed in 6 (42.9%) patients and cyst formation was observed in 8 patients (57.1%). Subtotal resection was performed in 13 (92.9%) patients and gross total resection was only achieved in one (7.1%) patient. Postoperative facial paresis occurred in 5 (35.7%) patients. Postoperative surgical complications occurred in 2 (14.3%) patients. After salvage resection for irradiated VS, no patient showed tumor progression or recurrence during the follow-up period (13 subtotal resection and 1 total resection). In addition, 2 patients in the subtotal resection group showed residual tumor shrinkage after salvage surgery during the follow-up periodConclusion: The behavior of residual tumors after salvage surgery for irradiated VS was stable. Adjuvant treatment for these residual tumors may not be necessary.

scholarly journals Fate of residual tumor after subtotal-resected, previously-irradiated vestibular schwannoma: Long-term follow-up of a single institutional series

2021 ◽  
Author(s):  
Joonho Byun ◽  
Sang Woo Song ◽  
Young-Hoon Kim ◽  
Chang Ki Hong ◽  
Jeong Hoon Kim
Keyword(s):  
Vestibular Schwannoma ◽  
Salvage Surgery ◽  
Residual Tumor ◽  
Cyst Formation ◽  
Subtotal Resection ◽  
Total Resection ◽  
Salvage Resection ◽  
Long Term Follow Up ◽  
History Of

Abstract Background The fate of residual tumor after salvage surgery for recurrent vestibular schwannoma (VS) after radiosurgery has not been elucidated. We reviewed our surgical series of salvage surgery for recurrent VS and the natural history of the residual tumor after salvage surgery. Methods This study enrolled 14 patients who were received salvage surgical resection in our institute and were followed-up for > 12 months. Results There were 3 male and 11 female patients with a median age of 55 years (range: 16–70). The pre-SRS tumor volume was a median 6591 mm3. All patients were treated by GKS. The median duration from GKS to surgery was 52 months (range: 10–116). Solid tumor growth was observed in 6 (42.9%) patients and cyst formation was observed in 8 patients (57.1%). Subtotal resection was performed in 13 (92.9%) patients and gross total resection was only achieved in one (7.1%) patient. Postoperative facial paresis occurred in 5 (35.7%) patients. Postoperative surgical complications occurred in 2 (14.3%) patients. After salvage resection for irradiated VS, no patient showed tumor progression or recurrence during the follow-up period (13 subtotal resection and 1 total resection). In addition, 2 patients in the subtotal resection group showed residual tumor shrinkage after salvage surgery during the follow-up period Conclusion The behavior of residual tumors after salvage surgery for irradiated VS was stable. Adjuvant treatment for these residual tumors may not be necessary.

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 Thirteen-year follow-up of parasellar intravascular papillary endothelial hyperplasia successfully treated by surgical excision: case report

2015 ◽  
Vol 15 (4) ◽  
pp. 384-391 ◽  
Author(s):  
Sook Young Sim ◽  
Yong Cheol Lim ◽  
Keun Soo Won ◽  
Kyung Gi Cho
Keyword(s):  
Surgical Excision ◽  
Subtotal Resection ◽  
Intravascular Papillary Endothelial Hyperplasia ◽  
Long Term Follow Up ◽  
History Of ◽  
Papillary Endothelial Hyperplasia ◽  
The Right ◽  
Frontal Skull Base

Intracranial intravascular papillary endothelial hyperplasia (IPEH) is very rare, and to our knowledge long-term follow-up results have not been previously published. An 11-year-old boy presented with a 6-month history of progressive visual impairment in the right eye. Magnetic resonance imaging revealed a well-enhanced, large parasellar mass involving the cavernous sinus, right frontal skull base, and ethmoid and sphenoid sinuses. Frontotemporal craniotomy and subtotal resection were performed, and the diagnosis of IPEH was confirmed. The mass increased in size during the following 3 months. A second operation was performed via frontotemporal craniotomy combined with a transsphenoidal approach, and gross-total resection of the tumor was achieved. Adjuvant radiotherapy (5040 cGy) and chemotherapy with interferon were administered. The patient's visual symptoms improved, and there was no recurrence during a 13-year follow-up period. The results of this case indicate that intracranial IPEH can recur with subtotal resection; however, optimal resection with multimodal adjuvant treatment can control the disease for many years, if not permanently.

Combined Endoscopic and Exoscopic Resection of Intracranial Epidermoid Cysts

2021 ◽  
Author(s):  
Li Chuzhong ◽  
Li Zhenye ◽  
Gui Songbai ◽  
Zhao Peng ◽  
Bai Jiwei ◽  
...  
Keyword(s):  
Residual Tumor ◽  
Subtotal Resection ◽  
Total Resection ◽  
Epidermoid Cysts ◽  
Postoperative Hematoma ◽  
Practical Experiences ◽  
Intracranial Epidermoid ◽  
Further Development ◽  
Panoramic Views

Abstract Objective In the past ten years, a fully endoscopic technique has also been widely used. Exoscope has also been developed for microneurosurgery which offers quality image and convenient manipulation. This article aims at introducing an endoscopic-exoscopic technique for the resection of epidermoid cysts. Methods We retrospectively analyzed the patients with intracranial epidermoid cysts who received whole course combined endoscopic and exoscopic resection between 2017 and 2020 at our institution, to explore the benefit of combined endoscopic and exoscopic resection of intracranial epidermoid cysts and evaluated the clinical utility of endoscopic-exoscopic technique. Results A total of 17 patients were enrolled in the study. Of all patients, 6 patients (6/17, 35.3%) underwent total resection, 10 patients (10/17, 58.8%) underwent subtotal resection (residual capsule and/or) and 1 patients (1/17, 5.9%) underwent partial resection. Postoperative surgical complications were seen in 3 patients (3/17, 17.6%), including intracranial infection in 2 patients (2/17, 11.8%), and a delayed postoperative hematoma observed in the seventh day after operation for 1 patient (1/17, 5.9%), who was treated in a conservative manner and recovered smoothly from the hemorrhage. The median follow-up time was 33.3 months (range 14.5-54.5 months). During the follow-up period, there was no recurrence of the tumors that received total resection. 2 patients developed residual tumor regrowth but did not show any symptom therefore no further surgery was required. Conclusions Endoscopic-exoscopic technique is safe and efficient in the resection of intracranial epidermoid cysts with panoramic views and superior maneuverability. With further development and accumulation of practical experiences, the endoscopic-exoscopic technique can also be applied in the resection of other intracranial tumors.

322 Rate of Residual Tumor Growth After Primary Subtotal Resection (STR) and the Role of Upfront Versus Salvage Stereotactic Radiosurgery (SRS) for Sporadic Vestibular Schwannomas

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 270-270
Author(s):  
Jonathan D Breshears ◽  
Carlene Partow ◽  
Tarik Tihan ◽  
Michael William McDermott ◽  
Patricia Sneed ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Salvage Surgery ◽  
Residual Tumor ◽  
Salvage Treatment ◽  
Vestibular Schwannomas ◽  
Subtotal Resection

Abstract INTRODUCTION Maximal safe resection is an optimal surgical strategy for moderate-to-large vestibular schwannomas, however data on the long-term outcomes of residual tumor after STR is lacking. The goal of this study was to review our rates of residual tumor growth, and the control rates of salvage versus upfront stereotactic radiosurgery (SRS). METHODS This retrospective single-institution study included all sporadic vestibular schwannomas treated primarily with STR at our institution from 2002 2015. The primary outcome was tumor growth requiring salvage treatment, and response to salvage treatment (surgery or SRS). Patients treated with upfront SRS after surgery were analyzed separately. RESULTS >295 patients underwent primary surgery for a vestibular schwannoma between 2002 - 2015, including 140 STRs. 49 cases with <1 year follow-up were excluded. 17 cases received upfront SRS after surgery (12 Gamma Knife, 12Gy; 5 CyberKnife, 25Gy in 5 fractions), with 2 failures requiring salvage surgery at 1.6 and 2.6 years (88% control rate at 1.8 years). Seventy-four residual tumors were managed with observation after STR. 57 (77%) remained stable at a median 4.1 years. 17 tumors (23%) progressed, requiring salvage treatment at a median of 2.8 years. Eleven received Gamma Knife (12.5 Gy) with a 100% control rate 2.3 years after SRS. One received Cyber Knife (18Gy, 3 fractions), ultimately requiring repeat surgery 3 years later. 4 residual tumors received salvage surgery at a median interval of 5 years after STR, and one was lost to follow-up. The control rate of salvage SRS was 92% at 2.3 years median follow-up. CONCLUSION A majority (77%) of residual vestibular schwannomas remained stable after a primary STR. Both upfront and salvage SRS had good control rates (∼90%) in our series. Further study is needed to define the role of upfront versus salvage SRS after a primary STR.

scholarly journals Long-term Follow-up of Pediatric Benign Cerebellar Astrocytomas

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Hideki Ogiwara ◽  
Robin M. Bowman ◽  
Tadanori Tomita
Keyword(s):  
Tumor Recurrence ◽  
Spontaneous Regression ◽  
Residual Tumor ◽  
Subtotal Resection ◽  
Total Resection ◽  
Postoperative Imaging ◽  
Group A ◽  
Group B

Abstract BACKGROUND The long-term prognosis of cerebellar astrocytomas needs to be reviewed. OBJECTIVE To elucidate the factors influencing tumor recurrence or progression and to determine how long these patient with cerebellar astrocytomas require surveillance with neuroimaging. METHODS A retrospective review of 101 children surgically treated for a cerebellar astrocytoma and followed up for &lt; 10 years was performed. RESULTS Mean follow-up was 18.4 years. Total resection confirmed by postoperative imaging was performed in 51 patients (50.5%; group A). Twenty-three patients (22.8%) had surgical total resection; however, equivocal residual tumor was found on postoperative imaging (group B). Subtotal resection leaving a portion of brainstem or cerebellar peduncle was performed in 27 patients (26.7; group C). Of these 50 residual tumors, 16 (32%) showed spontaneous regression and 8 (16%) showed arrested growth. Radiographic recurrence or progression was noted in 29 patients (28.7%). Only 3 of 51 patients (5.9%) of group A with total resection had recurrence, whereas 26 of 50 residual tumors (52%; groups B and C) progressed. The only factor affecting recurrence or progression by multivariate analysis was the extent of surgical resection. All tumor recurrence or progression except for 1 (96.6%) occurred within 8 years from the original surgery (range, 2–132 months). CONCLUSIONS Overall prognosis of cerebellar astrocytomas is good; the 10-year survival rate was 100% and recurrence- or progression-free rate was 71.3% in our cohort. Almost half of residual tumors showed spontaneous regression or arrested growth in the long term. Eight to 10 years is considered to be a reasonable follow-up period by neuroimaging.

scholarly journals Spinal drop of atypical choroid plexus papilloma in an adult patient: A case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 409
Author(s):  
Diego Ochoa-Cacique ◽  
María Córdoba-Mosqueda ◽  
José Ramón Aguilar-Calderón ◽  
Martha Cristina Sánchez-Silva ◽  
Rosa María Vicuña-González ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Choroid Plexus Papilloma ◽  
Radicular Pain ◽  
Subtotal Resection ◽  
Resonance Imaging ◽  
Spinal Level ◽  
Total Resection ◽  
First Case ◽  
History Of

Background: Choroid plexus papillomas (CPPs) are benign extra-axial tumors that originate from the choroid plexus; these tumors rarely have metastases, being at the spinal level the location with few reported cases. Case Description: We report the case of a 48-year-old man with a history of atypical fourth ventricular CPP and gross total resection (GTR) in 2008. In 2015, he presented with radicular pain, decreased strength, and paresthesia in the left leg. Magnetic resonance imaging revealed a well-defined intradural ovoid lesion in the vertebral canal at the level of the L3-L4 intersomatic space. Subtotal resection of the tumor was performed. The patient recovered well, with relief of pain and no neurological deficit. A literature research few cases of CPP metastasis in adults. We describe here a fifth-decade male patient with a lumbar neoplasm, which according to the histopathologic characteristics and location is the first case of an atypical papilloma implant of the choroid plexus at this spinal level. Conclusion: GTR of primary lesions and associated implants remains the gold standard for surgical treatment of CPP. Radiotherapy, stereotactic radiosurgery, and chemotherapy are adjuvant therapies for CPP but there is no definitive protocol for the management of implants. Proper follow-up of these patients is essential since spinal drop can appear many years after the initial presentation of CPP.

scholarly journals Pediatric case of presacral ganglioneuroma: diagnostic considerations and therapeutic strategy

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Saloua Ammar ◽  
Taycir Cheikhrouhou ◽  
Mohamed Jallouli ◽  
Rahma Chtourou ◽  
Sahla Sellami ◽  
...  
Keyword(s):  
Abdominal Mass ◽  
Surgical Excision ◽  
Residual Tumor ◽  
Posterior Mediastinum ◽  
Subtotal Resection ◽  
Case Presentation ◽  
Long Term Follow Up ◽  
Neuroblastic Tumors

Abstract Background Ganglioneuroma (GN) is an uncommon tumor belonging to the neuroblastic tumors group and is often localized in the posterior mediastinum, retroperitoneum, and adrenal gland. Presacral (PS) location is extremely rare. Its management remains a challenge. Case presentation A 4-year-old child presented to our department for an isolated abdominal mass. Para-clinical exams concluded to PSGN. Subtotal surgical excision was performed through an anterior transperitoneal approach. The size of the residual tumor did not progress after the 6-year follow-up period and the patients were asymptomatic. Conclusions GN should be considered in the case of soft tissue presacral masses in pediatrics. Subtotal resection seems sufficient in case of an extension to the sacrum with low morbidity. The residual tumors are still stable and the prognosis seems conserved. Further, long-term follow-up in large studies is needed to confirm these findings.

Patient Outcome at Long-term Follow-up after Aggressive Microsurgical Resection of Cranial Base Chondrosarcomas

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1090-1098 ◽  
Author(s):  
Fotios Tzortzidis ◽  
Foad Elahi ◽  
Donald C. Wright ◽  
Nancy Temkin ◽  
Sabareesh K. Natarajan ◽  
...  
Keyword(s):  
Cranial Base ◽  
Gross Total Resection ◽  
Cerebrospinal Fluid Leakage ◽  
Subtotal Resection ◽  
Incomplete Resection ◽  
Total Resection ◽  
Long Term Follow Up ◽  
Microsurgical Resection

Abstract OBJECTIVE: To evaluate patient clinical outcome and survival at long-term follow-up after aggressive microsurgical resection of chondrosarcomas of the cranial base. METHODS: Over a 20-year period, 47 patients underwent 72 operative procedures for resection of cranial base chondrosarcomas. Thirty-three patients were previously untreated, whereas 14 patients previously had undergone surgery or radiation. Twenty-three patients had a single operation and 24 underwent staged (more than one) operations because of extensive disease. Patients who underwent subtotal resection also underwent radiotherapy or radiosurgery. Patients were evaluated at follow-up clinically and by imaging studies. RESULTS: Gross total resection was accomplished in 29 (61.7%) patients, and subtotal resection was accomplished in 18 patients (38.3%). The resection was better in patients who underwent a primary operation (gross total resection, 68.8 versus 46.7%) rather than a reoperation. Patients who underwent incomplete resection underwent postoperative radiotherapy, which included proton beam radiotherapy (15.6%), radiosurgery (68%), and fractionated radiation (15.6%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 10 patients (18%). The follow-up ranged from 2 to 255 months, with an average of 86 months. At the conclusion of study, 36 (76.6%) patients were alive, and 21 (44.7%) patients were alive without disease. Recurrence-free survival was 32% at 10 years in all patients, 42.3% in primary patients and 13.8% in those who underwent reoperation. The Karnofsky performance score was 82.4 ± 9.8 before surgery, 85 ± 12.5 at 1 year after surgery, and 85.3 ± 5.8 at the latest follow-up. Two patients died as a result of radiotherapy complications (malignancy, radiation necrosis). CONCLUSION: Cranial base chondrosarcomas can be managed well by complete surgical resection or by a combination of surgery and radiotherapy. The study cannot comment about the efficacy of radiotherapy. Approximately half of the patients survived without recurrence at long-term follow-up (&gt;132 mo). The functional status of the surviving patients was excellent at follow-up.

scholarly journals Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

2017 ◽  
Vol 79 (02) ◽  
pp. 167-172 ◽  
Author(s):  
Ahmed Farhoud ◽  
Wael Khedr ◽  
Hisham Aboul-Enein
Keyword(s):  
Cranial Nerves ◽  
Postoperative Mortality ◽  
Residual Tumor ◽  
Retrosigmoid Approach ◽  
Subtotal Resection ◽  
Total Resection ◽  
Surgical Strategies ◽  
Epidermoid Cysts ◽  
Presenting Symptoms

Objective Epidermoid cysts are benign slowly growing tumors commonly involving the cerebellopontine angle (CPA). The aim of this study was to analyze the surgical limitations, surgical strategies, complications, and outcome of resection of these lesions. Material and Methods The clinical data and outcome of 32 cases operated for CPA epidermoid between 2007 and 2015 were retrospectively analyzed. The mean follow-up period was 42.6 months, and all patients were followed up at least for a whole year. Results There were 15 males and 17 females. The median age was 37.6 years. Headache and cranial nerves dysfunction were the most common presenting symptoms. Surgery was performed in all patients using the standard lateral suboccipital retrosigmoid approach. In three cases, microvascular decompression of an arterial loop was performed in addition to tumor excision. Total resection was accomplished in 19 out of 32 cases (59.4%), subtotal resection in 7 cases (21.9%), and only partial excision was achieved in 6 cases (18.7%). There was no recurrence or regrowth of residual tumor during the follow-up period. We had a single postoperative mortality due to postoperative pneumonia and septic shock. New cranial nerves deficits occurred in 15.6% of cases but were transient in most of them. Conclusion The favorable outcome of total resection of CPA epidermoids should always be weighed against the critical risks that accompany it especially in the presence of tight adhesions to vital neurovascular structures. The retrosigmoid approach is suitable for the resection of these tumors even if they were large in size.

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