Article
Recurrence rate, time to progression and facial nerve function in surgery of vestibular schwannomas
Rezidivrate, Progressionsintervall und Facialisfunktion nach Operation von Vestibularisschwannomen
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Authors
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C. Trantakis
- Klinik und Poliklinik für Neurochirurgie, Universität Leipzig
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F. Arlt
- Klinik und Poliklinik für Neurochirurgie, Universität Leipzig
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V. Seifert
- Klinik und Poliklinik für Neurochirurgie, Johann-Wolfgang-Goethe Universität Frankfurt
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F. Bootz
- HNO-Klinik, Rheinische Friedrich-Wilhelms-Universität Bonn
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G. Strauss
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde / Plastische Operationen, Universität Leipzig
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J. Meixensberger
- Klinik und Poliklinik für Neurochirurgie, Universität Leipzig
| Published: | May 30, 2008 |
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Outline
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Objective: Recurrence rate, time to progression and facial nerve function were analysed in a retrospective study comparing patients with complete and nearly complete tumor removal.
Methods: From 1996 to 2004 118 patients with a vestibular schwannoma were operated by way of an interdisciplinary neurosurgical and ENT-surgical approach using intraoperative monitoring. 50 patients fulfilled the criteria of suboccipital approach, pre- and at least 2 postoperative MRI as well as a follow-up of at least 12 months and were included in the study. Patients with neurofibromatosis II were excluded. Recurrence was defined as progression of ≥2 mm of the largest diameter in the MRI. MRI was performed preoperatively and postoperatively in the follow-up once a year. Tumor size, facial nerve function estimated using the House-Brackmann Score (HBS), time to progression and recurrence rate were analysed and related to the extent of resection.
Results: In 28 cases (group I) a small capsule remnant was left. In 22 cases (group II) there was no tumor remnant in the postoperative MRI. The median follow-up was 52 months in group I and 50,5 months in group II without significant difference.
Recurrence rate: In group I 9 patients (32,1 %) showed progression in the follow-up. In group II 2 patients (9,1%) developed a recurrent tumor. The difference was significant. The median time to progression was not different.
Facial nerve function and degree of resection: 53,6% in the group I and 59,6 % in the group II had a good function (HBS I+II), 28,6 % in group I and 13,5 % in group II had a moderate disturbance (HBS III+IV). 17,9 % in group I and 27,7% in group II had a poor function (HBS V+VI). There was no significant difference between the groups.
Facial nerve function and tumor size: There was no significant difference between median preoperative tumor size and postoperative HBS between the groups whereas larger tumors were associated with facial nerve dysfunction within group II.
Conclusions: Facial nerve function is crucial for the quality of life. Complete tumor removal may be associated with a risk of functional loss whereas nearly complete tumor removal may be associated with a risk of progression. The data in the study suggest that facial nerve function can be preserved when leaving small capsular remnants of the facial nerve in case of a large tumor. The increased risk of progression necessetates MRI control in the follow-up to decide about further therapy.
