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J Neurol Surg B Skull Base
DOI: 10.1055/a-2297-3849
Original Article

Clinical Outcomes of Salvage Microsurgical Resection after Radiation Therapy for Sporadic Vestibular Schwannomas

Omid Moshtaghi   *
1   Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, United States
,
Patrick Barba    *
2   Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, United States
,
Peter Dixon
1   Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, United States
,
Yin Ren
1   Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, United States
,
Marc Schwartz
3   Department of Neurosurgery, University of California, San Diego, La Jolla, California, United States
,
Rick Friedman
1   Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, United States
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Abstract

Background The purpose of this study was to evaluate clinical outcomes after salvage microsurgery for vestibular schwannoma (VS) treated initially with modern radiotherapy techniques as compared to those treated with primary microsurgical resection.

Methods Patients who underwent microsurgical resection of sporadic VS undergoing a translabyrinthine approach at a single academic skull base tertiary referral center were included. Baseline and postoperative dynamic gait index, functional gait assessment, House–Brackmann facial nerve grading, and completeness of resection were prospectively recorded.

Results Of the 265 patients reviewed, 21 (7.9%) patients underwent prior radiation. Median age of the cohort was 55 years (interquartile range: 51–63). The likelihood of achieving a gross total resection was significantly lower for radiated as compared to nonradiated patients (odds ratio: 0.18, 95% confidence interval: 0.05–0.53, p = 0.004) when controlling for tumor size. Radiated patients had better postoperative facial nerve function on the first postoperative day, but this difference was not significant at long-term follow-up. Radiated patients had lower preoperative postural stability scores than nonradiated patients on FGA (26 vs. 23, p = 0.035). Postoperatively, radiated patients had comparable outcomes compared to nonradiated patients when controlling for age and tumor size.

Conclusions Compared to patients with VS treated with surgery alone, previously radiated patients are less likely to achieve gross total resection in the salvage setting. Radiated patients scored better on facial nerve outcomes compared to nonradiated patients in the initial postoperative period but demonstrated similar long-term outcomes.

Keywords

vestibular schwannoma - radiation - salvage - microsurgery

* These authors contributed equally.




Publication History

Received: 31 March 2023

Accepted: 22 March 2024

Accepted Manuscript online:
01 April 2024

Article published online:
25 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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