Article
The impact of the MIB-I index on facial nerve outcome in vestibular schwannoma surgery
Der Einfluss des MIB-I Index auf das Outcome des N. facialis nach chirurgischer Therapie des Vestibularisschwannoms
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Published: | May 8, 2019 |
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Objective: Objective of this study was to evaluate facial nerve outcomes in the surgical treatment of vestibular schwannomas (VS) based on extent of resection, tumor size, surgical positioning and immunohistochemical factors.
Methods: 118 patients with VS were analyzed retrospectively. Gross total resection (GTR) was achieved in 83 patients, and subtotal resection (STR) in 35 patients. Follow-up was 60 months (median). Facial nerve outcome was assessed for 24 months after surgery and analyzed in regard to tumor size class, extent of resection, and surgical positioning. MIB-I Index was available in 114 of the 118 patients and analyzed concerning recurrence and facial nerve outcome. Uni- and multivariate analyses were performed.
Results: Immediately after surgery, 16 of 35 patients (48.6%) with STR, and 21 of 83 patients (24.1%) with GTR had a good (House-Brackmann score ≤2) postoperative facial nerve outcome (p=0.029). Semi-sitting positioning was superior to lateral positioning concerning postoperative facial nerve outcome (p=0.002). Tumor size class 3 (>4cm) was associated with worse HB outcome after 2 years (p=0.004), and VP shunt dependency (3 of 19; 21.05%; p=0.04). Recurrence rates did not differ between the groups of GTR and STR (p=0.7). Recurrence estimation was 59.2 (CI: 57.5–60.9) months for GTR, and 58 (CI: 52.7–63.3) months in STR. MIB-I score did not correlate with recurrence. However, MIB-I score ≥5% was a predictor for worse HB score after 1 year (16/28 (57.1%) vs. 5/40 (12.5%); p: <0.001) in the multivariate analysis.
Conclusion: MIB-I score seems to be a predictor for facial nerve outcome in vestibular schwannoma surgery. Recurrence free survival seems to be equal in GTR and STR.