The fate of the tumor remnant after less-than-complete acoustic neuroma resection.
OBJECTIVE
We sought to determine the recurrence rate after near-total and subtotal resection of acoustic neuroma.


METHODS
We conducted a retrospective chart review of a total of 79 patients: 50 with near-total resections (remnant < or =25 mm(2) and < or =2 mm thick) and 29 with subtotal resections (any larger remnant). Surgical approach included 5 middle fossa, 17 retrosigmoid, and 57 translabyrinthine.


METHODS
Recurrence was defined as documented tumor growth by serial imaging or the recommendation for further treatment after a single scan. No recurrence was defined as no visible tumor on imaging for a minimum follow-up time of 3 years or tumor remnants that remained unchanged on serial scans (mean, 5-year follow-up).


RESULTS
Fifty-two patients were included in the study group. Recurrences were seen in 1 (3%) of 33 patients who had a near-total resection compared with 6 (32%) of 19 patients who had a subtotal resection. After adjustment for follow-up time and large tumor size, the odds ratio for recurrence was 12 times larger for subtotal than for near-total resections (P = 0.033). All recurrences were seen following the translabyrinthine approach in the mid-cerebellopontine angle. None were encountered in the internal auditory canal. The mean time interval from surgery to the detection of a recurrence was 3 years (range, 1 to 5 years).


CONCLUSIONS
The recurrence rate when performing a near-total resection is low but is substantially higher with a subtotal resection. Recurrences can be detected within the first 5 postoperative years. We recommend near-total resection in any patient if needed to preserve neural integrity. Subtotal resection is best avoided whenever possible; however, adjunctive treatment with stereotactic radiotherapy may be considered.
Bloch
Dov C
DC
Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, USA.
Oghalai
John S
JS
Jackler
Robert K
RK
Osofsky
Monica
M
Pitts
Lawrence H
LH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D018365:Neoplasm, Residual; D009464:Neuroma, Acoustic / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures; D012189:Retrospective Studies; D018570:Risk Assessment