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Tumor Rapid Fire Abstract

Tumor

Outcomes of Subtotal Resection for Vestibular Schwannoma Post-Stereotactic Radiosurgery: Emphasizing Facial Nerve Preservation

Sunday, May 5, 2024
1:35 PM – 1:37 PM CT
Location:  S405a
Disclosure(s):
Othman Bin-Alamer, MBBS: No financial relationships to disclose
Introduction: Vestibular schwannomas (VS) are often managed with stereotactic radiosurgery (SRS). Challenges arise when the tumor progresses following SRS, with significant concerns regarding facial nerve function. This investigation focuses on the outcomes of facial nerve preservation post-subtotal resection (STR) in patients whose tumors progressed after initial SRS.

Methods: An institutional SRS database was retrospectively reviewed to identify 18 patients (61.1% male) who underwent STR following SRS failure. Pre-SRS House-Brackmann (HB) scores were predominantly grade I (88.9%). Symptoms such as hearing loss (16 patients) and tinnitus (13 patients) were reported post-progression, with the majority of patients (83.3%) maintaining their HB score post-STR.

Results: The median patient age was 60 years at surgery, with a median tumor volume of 9.3 cc. Surgical approaches were retrosigmoid (88.9%), translabyrinthine (5.6%), and suboccipital craniotomy (5.6%), with a median operative time of 509 minutes and median blood loss of 375 mL. Post-surgical HB scores were I in seven patients, II in four, III in three, IV in one, V in one, and VI in one patient (this patient was grad IV prior to surgery). GR scores post-surgery were primarily grade V (88.9%). At a median follow-up of 50 months, no recurrences were reported, and all patients were alive.

Conclusion : STR for VS after failed SRS may preserve facial nerve function in select patients. However, the high complication rate underscores the need for meticulous patient selection to optimize outcomes and minimize surgical morbidity. Our data indicate that while the risk of surgery is not insignificant, it can be a viable option when SRS is no longer effective, provided that patients are carefully chosen based on their individual circumstances.