Surgical salvage after failed irradiation for vestibular schwannoma.
OBJECTIVE
Compare vestibular schwannoma (VS) surgical outcome between patients with prior irradiation and those not previously treated.


METHODS
Retrospective review with matched control group.


METHODS
Review of tumor adherence to the facial nerve, facial nerve grade, and complications in 38 patients with radiotherapy as a primary procedure before VS surgical removal and a matched random sample of 38 patients with primary surgery. The majority of the irradiated group had gamma knife radiation therapy. Mean time from irradiation to surgical salvage was 3.3 years (SD = 3.2), with a minimum of 5.2 months and a maximum of 15.8 years. Most (89.5%) patients in each group underwent a translabyrinthine approach. Mean tumor size at surgery was 2.6 cm in each group.


RESULTS
The irradiated group had more moderate to severe adherence of tumor than the controls (89% vs. 63%, P < or = .01). They also had a lower rate of good facial function (House-Brackmann grade I/II) (37% vs. 70%) and a higher rate of poor function (grades V or VI) (50% vs. 18%) at follow-up (P < or = .019). Results were similar when including only those with good preoperative function (50% vs. 72% and 32% vs. 15%) but did not achieve statistical significance. Surgical time and complications did not differ.


CONCLUSIONS
Patients who have undergone irradiation for VS and require surgical salvage may have a more difficult surgery and poorer outcomes than those not previously irradiated. When making their initial choice of treatment, patients should be counseled that surgery might be more difficult after failed stereotactic irradiation.
Friedman
Rick A
RA
House Clinic and House Ear Institute, Los Angeles, CA 90057, USA. rfriedman@hei.org
Brackmann
Derald E
DE
Hitselberger
William E
WE
Schwartz
Marc S
MS
Iqbal
Zarina
Z
Berliner
Karen I
KI
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000532:radiotherapy* / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome