Surgical salvage of recurrent vestibular schwannoma following prior stereotactic radiosurgery.
To evaluate outcomes of salvage surgery for vestibular schwannoma (VS) that failed primary stereotactic radiosurgery (SRS).



Case-control study of 37 patients who underwent surgical resection of sporadic VS following prior SRS at two tertiary academic referral centers between 2003 and 2015. A cohort of nonirradiated control subjects, matched according to tumor size, age, and treatment center, were used as comparison.



Thirty-seven patients were included. The median time from radiation to surgical salvage was 36 months (range 9.6-153 months). Following tumor progression after SRS, 18 (49%) patients underwent gross total resection, 10 (27%) underwent near-total resection, and nine (24%) underwent subtotal resection. Postoperative complications following salvage surgery included one (3%) case of stroke, four (11%) cases of cerebrospinal fluid leak, and two (5%) cases of meningitis. Twenty-seven (73%) patients had good postoperative facial nerve outcome (House-Brackmann Score I-II) at long-term follow-up. There were no cases of tumor recurrence or regrowth after a median length of 26 months following microsurgical salvage (range 3-114 months). The rate of satisfactory postoperative facial nerve function was not different between study and control subjects (73% vs. 76%; P = 0.8); however, less-than-complete resection was utilized more frequently among previously radiated patients (P = 0.01).



Microsurgical salvage of VS following primary radiation therapy is challenging. Less-than-complete resection is required in a greater percentage of patients to preserve facial nerve integrity and prevent neurological complications. Long-term follow-up is needed to determine the risk of delayed progression following incomplete tumor removal.



3b. Laryngoscope, 126:2580-2586, 2016.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Stephanie C
SC
Wise
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Matthew L
ML
Carlson
Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Øystein Vesterli
ØV
Tveiten
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Colin L
CL
Driscoll
Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
Erling
E
Myrseth
Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Morten
M
Lund-Johansen
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.. link.michael@mayo.edu.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.. link.michael@mayo.edu.|Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway. link.michael@mayo.edu.
Michael J
MJ
Link
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005154:Facial Nerve / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009464:Neuroma, Acoustic / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects; D016879:Salvage Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
Vestibular schwannoma; acoustic neuroma; gamma knife; microsurgery; radiosurgery; recurrence