Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma

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  • 1 Departments of Neurologic Surgery,
  • 2 Otorhinolaryngology, and
  • 3 Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota; and
  • 4 Department of Neurosurgery, Graduate School of Medicine, University of Tokyo Hospital,Tokyo, Japan
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OBJECTIVE

The management of vestibular schwannoma (VS) remains controversial. One commonly cited advantage of microsurgery over other treatment modalities is that tumor removal provides the greatest chance of long-term cure. However, there are very few publications with long-term follow-up to support this assertion. The purpose of the current study is to report the very long-term risk of recurrence among a large historical cohort of patients who underwent microsurgical resection.

METHODS

The authors retrospectively reviewed the medical records of patients who had undergone primary microsurgical resection of unilateral VS via a retrosigmoid approach performed by a single neurosurgeon-neurotologist team between January 1980 and December 1999. Complete tumor removal was designated gross-total resection (GTR), and anything less than complete removal was designated subtotal resection (STR). The primary end point was radiological recurrence-free survival. Time-to-event analyses were performed to identify factors associated with recurrence.

RESULTS

Four hundred fourteen patients met the study inclusion criteria and were analyzed. Overall, 67 patients experienced recurrence at a median of 6.9 years following resection (IQR 3.9–12.1, range 1.2–22.5 years). Estimated recurrence-free survival rates at 5, 10, 15, and 20 years following resection were 93% (95% CI 91–96, 248 patients still at risk), 78% (72–85, 88), 68% (60–77, 47), and 51% (41–64, 22), respectively. The strongest predictor of recurrence was extent of resection, with patients who underwent STR having a nearly 11-fold greater risk of recurrence than the patients treated with GTR (HR 10.55, p < 0.001). Among the 18 patients treated with STR, 15 experienced recurrence at a median of 2.7 years following resection (IQR 1.9–8.9, range 1.2–18.7). Estimated recurrence-free survival rates at 5, 10, 15, and 20 years following GTR were 96% (95% CI 93–98, 241 patients still at risk), 82% (77–89, 86), 73% (65–81, 46), and 56% (45–70, 22), respectively. Estimated recurrence-free survival rates at 5, 10, and 15 years following STR were 47% (95% CI 28–78, 7 patients still at risk), 17% (5–55, 2), and 8% (1–52, 1), respectively.

CONCLUSIONS

Long-term surveillance is required following microsurgical resection of VS even after GTR. Subtotal resection alone should not be considered a definitive long-term cure. These data emphasize the importance of long-term follow-up when reporting tumor control outcomes for VS.

ABBREVIATIONS AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; CPA = cerebellopontine angle; GTR = gross-total resection; HB = House-Brackmann; IAC = internal auditory canal; STR = subtotal resection; VS = vestibular schwannoma.

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Contributor Notes

Correspondence Michael J. Link, Department of Neurologic Surgery, Mayo Clinic, 200 First St., SW, Rochester, MN 55905. email: link.michael@mayo.edu.

INCLUDE WHEN CITING Published online May 19, 2017; DOI: 10.3171/2016.11.JNS16498.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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