Extent of resection and the long-term durability of vestibular schwannoma surgery

Clinical article

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Object

With limited studies available, the correlation between the extent of resection and tumor recurrence in vestibular schwannomas (VSs) has not been definitively established. In this prospective study, the authors evaluated 772 patients who underwent microsurgical resection of VSs to analyze the association between total tumor resection and the tumor recurrence rate.

Methods

The authors selected all cases from a prospectively collected database of patients who underwent microsurgical resection as their initial treatment for a histopathologically confirmed VS. Recurrence-free survival was analyzed using Kaplan-Meier analysis. The authors studied the impact of possible confounders such as patient age and tumor size using stepwise Cox regression to calculate the proportional hazard ratio of recurrence while controlling for other cofounding variables.

Results

The authors analyzed data obtained in 571, 89, and 112 patients in whom gross-total, near-total, and subtotal resections, respectively, were performed. A gross-total resection was achieved in 74% of the patients, and the overall recurrence rate in these patients 8.8%. There was no significant relation between the extent of resection and the rate of tumor recurrence (p = 0.58). As expected, the extent of resection was highly correlated with patient age, tumor size, and surgical approach (p < 0.0001). Using Cox regression, the authors found that the approach used did not significantly affect tumor control when the extent of resection was controlled for.

Conclusions

While complete tumor removal is ideal, the results presented here suggest that there is no significant relationship between the extent of resection and tumor recurrence.

Abbreviations used in this paper: GTR = gross-total resection; HR = hazard ratio; NTR = near-total resection; STR = subtotal resection; VS = vestibular schwannoma.

Article Information

Address correspondence to: Andrew T. Parsa, M.D., Ph.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, California 94143. email: parsaa@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online January 21, 2011; DOI: 10.3171/2010.11.JNS10257.

© AANS, except where prohibited by US copyright law.

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Figures

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    Kaplan-Meier analysis comparing the rate of tumor recurrence between extent of resection (GTR vs NTR vs STR) (A), a subgroup analysis of STR patients divided by size of the lesion on postoperative imaging (B), surgical approaches (middle cranial fossa [MCF] vs retrosigmoid craniotomy [RS] vs translabyrinthine craniotomy [TL]) (C), patient age (≤ 55 years vs those 56–70 years vs those > 70 years of age) (D), and preoperative tumor size (≤ 1.5 cm vs 1.6–3.0 cm vs > 3.0 cm) (E). NS = not significant.

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