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Intended Near-Total Removal of Koos Grade IV Vestibular Schwannomas: Reconsidering the Treatment Paradigm.
Zumofen, Daniel Walter; Guffi, Tommaso; Epple, Christian; Westermann, Birgit; Krähenbühl, Anna-Katharina; Zabka, Susanne; Taub, Ethan; Bodmer, Daniel; Mariani, Luigi.
Afiliación
  • Zumofen DW; Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
  • Guffi T; Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel, Switzerland.
  • Epple C; Faculty of Medicine, University of Lausanne, Lausanne, Switzerland.
  • Westermann B; Department of Biomedicine, Basel University Hospital, Basel, Switzerland.
  • Krähenbühl AK; Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
  • Zabka S; Department of Neurosurgery, Bern University Hospital, Bern, Switzerland.
  • Taub E; Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
  • Bodmer D; Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
  • Mariani L; Department of Otolaryngology, Basel University Hospital, Basel, Switzerland.
Neurosurgery ; 82(2): 202-210, 2018 02 01.
Article en En | MEDLINE | ID: mdl-28383680
BACKGROUND: The goals of treating Koos grade IV vestibular schwannomas are to relieve brainstem compression, preserve or restore neurological function, and achieve long-term tumor control while minimizing tumor- and treatment-related morbidity. OBJECTIVE: To propose a treatment paradigm involving the intentional near-total removal of Koos grade IV vestibular schwannomas, in which a small amount of residual tumor is not dissected off the cisternal portion of the facial nerve. Patients are then followed by a wait-and-scan approach. Any subsequent volumetric progression of the residual tumor is treated with radiosurgery. METHODS: This is a case series of 44 consecutive unselected patients who underwent intended near-total resection of a Koos grade IV vestibular schwannoma through a retrosigmoid approach from January 2009 to December 2015. Pre- and postoperative volumetric analyses were performed on routine magnetic resonance imaging sequences (constructive interference in steady state and gadolinium-enhanced T1-weighted sequence). RESULTS: The mean preoperative tumor volume was 10.9 cm3. The mean extent of resection was 89%. At the last clinical follow-up, facial nerve function was good [House and Brackmann (HB) I-II] in 89%, fair (HB III) in 9%, and poor (HB IV-VI) in 2% of the patients. At the last radiological follow-up, the residual tumor had become smaller or remained the same size in 84% of patients. Volumetric progression was negatively correlated with the original extent of resection and positively correlated with postoperative residual tumor volume (P = .01, P < .001, respectively). CONCLUSION: Intended near-total removal results in excellent preservation of facial nerve function and has a low recurrence rate. Any progressive residual tumor may be treated by radiosurgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neuroma Acústico / Procedimientos Neuroquirúrgicos Tipo de estudio: Observational_studies / Prognostic_studies Límite: Adult / Aged / Female / Humans / Middle aged Idioma: En Revista: Neurosurgery Año: 2018 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neuroma Acústico / Procedimientos Neuroquirúrgicos Tipo de estudio: Observational_studies / Prognostic_studies Límite: Adult / Aged / Female / Humans / Middle aged Idioma: En Revista: Neurosurgery Año: 2018 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos