title: Clinical and histopathologic features of recurrent vestibular schwannoma (acoustic neuroma) after stereotactic radiosurgery.
abstract: OBJECTIVE
  Stereotactic radiosurgery for vestibular schwannoma entails uncertain long-term risk of tumor recurrence and delayed cranial neuropathies. In addition, the underlying histopathologic changes to the tumor bed are not fully characterized. We seek to understand the clinical and histologic features of recurrent vestibular schwannoma after stereotactic radiation therapy.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Four patients who underwent microsurgical resection of vestibular schwannoma after primary stereotactic radiation therapy.
  
  
  METHODS
  Patients were treated primarily with gamma knife radiosurgery or fractionated stereotactic radiotherapy followed by salvage microsurgery. Retrosigmoid craniotomy was used in all cases.
  
  
  METHODS
  Histopathologic review. Preoperative and postoperative facial nerve function was assessed with the House-Brackmann scale.
  
  
  RESULTS
  We observed highly inconsistent radiation changes in the cerebellopontine angle and internal auditory canal. Fibrosis outside and within the tumor bed varied markedly, complicating microsurgical dissection. Light microscopy confirmed the presence of viable tumor in all cases. Histopathologic features were typical of vestibular schwannoma, and there was no significant scarring that could be attributed to radiation effect.
  
  
  CONCLUSIONS
  The variable fibrosis in the cerebellopontine angle and lack of radiation changes seen histopathologically in irradiated vestibular schwannoma suggest that a uniform treatment effect was not achieved in these cases. Although all four patients with preoperative cranial neuropathies were found intraoperatively to have fibrosis in the cerebellopontine angle, excellent preservation of facial nerve anatomy and function was possible with salvage microsurgical resection. Additional analyses are needed to clarify the histopathologic and molecular characteristics associated with vestibular schwannoma growth after stereotactic radiation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lee
authors.forename: William H
authors.initials: WH
authors.lastname: Westra
authors.forename: Hinrich
authors.initials: H
authors.lastname: Staecker
authors.forename: Donlin
authors.initials: D
authors.lastname: Long
authors.forename: John K
authors.initials: JK
authors.lastname: Niparko
authors.forename: William H
authors.initials: WH
authors.lastname: Slattery
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D013238:Stereotaxic Techniques