Abstract
Background and Purpose: The risk factors for progression in vestibular schwannomas (VSs) after incomplete resection (IR) remain to be elucidated. The purpose of this study was to investigate the risk factors for progression in remnant VSs after surgery.Methods: From January 2009 to January 2018, 140 consecutive patients who underwent IR of VSs via suboccipital retrosigmoid approach in our institution were retrospectively analyzed. During follow-up, if progression was detected, the patient was classified into Progressive Group (PG); if the residual tumor was stable or shrank, the patient was classified into Stable Group (SG). Univariate analysis and multivariate analysis were used to evaluate the risk factors for progression after IR of VSs.Results: After a mean follow-up of 80.4 months (range, 24–134 months), 35 (25.0%) patients (PG) had a progression, and no progression was detected in 105 (75.0%) patients (SG). The average tumor size was 36.5 ± 8.9 mm in PG and 31.0 ± 9.8 mm in SG, respectively. The residual tumor volume was 304.6 ± 443.3 mm3 in PG and 75.9 ± 60.0 mm3 in SG, respectively. Univariate analysis showed that preoperative tumor size, residual tumor volume, and irregular internal auditory canal (IAC) expansion were significantly different between the two groups, whereas gender, age, cystic component, or Ki-67 labeling index (LI) did not differ significantly between the two groups. Multivariate analysis showed residual tumor volume was the independent risk factor for progression.Conclusions: VSs that underwent IR with larger preoperative size, greater residual tumor volume, or irregular IAC expansion may have a higher progression rate. Strict follow-up with shorter interval in these patients to detect early progression is necessary.
Highlights
Vestibular schwannoma (VS) is a common benign neoplasm originating from the VIII cranial nerve sheath, accounting for around 8% of all intracranial tumors and 80% of cerebellopontine angle tumors [1,2,3]
In Progressive Group (PG), 15 cases (42.9%) underwent reoperation, among which 10 cases were totally removed after reoperation, three cases still had remnant tumor and two cases had third operation; six patients (17.1%) had gamma-knife radiosurgery and reoperation, among which five cases were totally resected after reoperation, and one case still had remnant tumor; another 14 cases (40%) had gamma-knife radiosurgery alone, among which eight cases were stable, and six were shrank
Enhanced magnetic resonance imaging (MRI) data were obtained in 27 cases in the PG before first operation, with an average preoperative tumor size of 36.5 ± 8.9 mm; enhanced MRI data were obtained in 82 cases in the Stable Group (SG) before operation, with an average tumor size of 31.0 ± 9.8 mm
Summary
Vestibular schwannoma (VS) is a common benign neoplasm originating from the VIII cranial nerve sheath, accounting for around 8% of all intracranial tumors and 80% of cerebellopontine angle tumors [1,2,3]. VS is a kind of benign neoplasm with slow growth rate, it has the potential for recurrence/regrowth regardless of any extent of resection (EOR), especially in patients with VS receiving IR. VSs have a different recurrence/regrowth rate when they receive different EOR, with 2.4–3.4%, 3–29%, 23.8– 52%, and 25–62.5% progression rate after total resection (TR), near total resection (NTR), subtotal resection (STR), and partial resection (PR), respectively [12,13,14,15,16,17]. Patients with VSs who underwent IR had a higher progression (regrowth) rate compared with those who received TR. The risk factors for progression in vestibular schwannomas (VSs) after incomplete resection (IR) remain to be elucidated. The purpose of this study was to investigate the risk factors for progression in remnant VSs after surgery
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