gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Microsurgical resection following radiotherapy and surgical resection of vestibular schwannomas: comparison of intraoperative findings and clinical outcomes with patients undergoing surgery for recurrent tumors

Meeting Abstract

  • B. Hong - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • M. Bremer - Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover
  • J.K. Krauss - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • J.H. Karstens - Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover
  • M. Nakamura - Neurochirurgische Klinik, Medizinische Hochschule Hannover

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.12.09

DOI: 10.3205/12dgnc274, URN: urn:nbn:de:0183-12dgnc2744

Published: June 4, 2012

© 2012 Hong et al.
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Outline

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Objective: Treatment strategies for vestibular schwannoma (VS) include microsurgical resection or radiotherapy (RT) in selected cases. In case of tumor recurrence, microsurgical resection is thought to be more challenging due to tumor adherence to the nerves and vital structures. The aim of this study was to compare the surgical difficulties and outcomes in patients presenting with a recurrent VS and patients who underwent prior RT as first line treatment in VS.

Methods: 313 patients underwent 320 microsurgical resections for VS during a 14-year period. 10 patients (group A) hat recurrent VS after prior microsurgery. 6 patients (group B) had undergone RT previously (Gamma Knife, n = 3, fractionated stereotactic RT, n = 3). The clinical findings, operative findings, and outcomes were retrospectively reviewed.

Results: The mean time between initial surgery and recurrent surgery was 93.1 months and the mean time between RT and surgery was 8.8 months. Tumor enlargement was observed in the most cases (group A, n = 8; group B, n = 3). Clinical findings before surgery were hearing loss (group A, n = 13; group B, n = 3), facial palsy (group A, n = 10; group B, n = 2), and disequilibrium (group A, n = 3; group B, n = 3). All patients underwent microsurgical resection via the retrosigmoid approach. Total resection was achieved in 10 patients of group A and 4 patients of group B. The tumor was more difficult to resect, particularly due to increased firmness in the consistency of the tumors and increased adhesions to surrounding tissues. Despite of such difficulties, anatomic preservation of the facial nerve could be achieved in nearly all patients (group A, n = 14; group B, n = 6). In 3 patients of group A, facial palsy deteriorated postoperatively and 2 patients exhibited new facial palsy. One patient had developed hearing loss following tumor resection. One patient of group B experienced deterioration of facial palsy after surgery. In 3 patients of group B with preoperative normal hearing and facial function, the preoperative function was preserved.

Conclusions: Although microsurgical resection after prior microsurgery or RT is uncommon, in selected cases surgery is necessary in case of tumor enlargement. Despite of increased surgical difficulty, complete tumor removal with preservation of neurological function is still possible. Regarding the facial nerve function, recurrent VS after initial microsurgery demonstrated a poorer outcome compared to those patients, who underwent RT for primary treatment.