Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2022
Predicting Extent of Microsurgical Resection of Sporadic Vestibular Schwannoma.
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Macielak Robert J, Lohse Christine M, Wallerius Katherine P, Lawlor Skye K, Neff Brian A, Van Gompel Jamie J, Driscoll Colin L W, Link Michael J, Carlson Matthew L
Аннотация
OBJECTIVE: Develop a predictive model for incomplete microsurgical resection of sporadic vestibular schwannoma (VS).
STUDY DESIGN: Historical cohort.
SETTING: Tertiary referral center.
PATIENTS: Patients with sporadic VS.
INTERVENTIONS: Microsurgery with preoperative intent of gross total resection.
MAIN OUTCOME MEASURES: Patient and tumor characteristics that influence extent of resection.
RESULTS: Among 603 patients, 101 (17%) had intracanalicular tumors and 502 (83%) had tumors with cerebellopontine angle (CPA) extension. For patients with CPA tumors, 331 (66%) underwent gross total resection and 171 (34%) underwent near-total or subtotal resection (NTR-STR). Multivariable modeling identified older age at surgery, larger linear tumor size, and absence of a fundal fluid cap as predictive of NTR-STR ( p < 0.001). From this model, one can estimate that a 20-year-old with a tumor that has less than 10 mm of CPA extension and a present fundal fluid cap has a predicted probability of NTR-STR of 0.01 (or 1%), whereas a 70-year-old with a tumor that has 30 mm or greater CPA extension and absence of a fundal fluid cap has a predicted probability of NTR-STR of 0.91 (or 91%). Among the 171 patients who underwent NTR-STR, 24 required secondary treatment at the time of last follow-up.
CONCLUSION: The primary predictors of incomplete microsurgical resection of VS include older age at surgery, larger linear tumor size, and absence of a fundal fluid cap. These factors can be used to estimate the likelihood of NTR-STR, aiding in preoperative discussions regarding future surveillance and potential need of secondary treatment, as well as shared clinical decision making.
STUDY DESIGN: Historical cohort.
SETTING: Tertiary referral center.
PATIENTS: Patients with sporadic VS.
INTERVENTIONS: Microsurgery with preoperative intent of gross total resection.
MAIN OUTCOME MEASURES: Patient and tumor characteristics that influence extent of resection.
RESULTS: Among 603 patients, 101 (17%) had intracanalicular tumors and 502 (83%) had tumors with cerebellopontine angle (CPA) extension. For patients with CPA tumors, 331 (66%) underwent gross total resection and 171 (34%) underwent near-total or subtotal resection (NTR-STR). Multivariable modeling identified older age at surgery, larger linear tumor size, and absence of a fundal fluid cap as predictive of NTR-STR ( p < 0.001). From this model, one can estimate that a 20-year-old with a tumor that has less than 10 mm of CPA extension and a present fundal fluid cap has a predicted probability of NTR-STR of 0.01 (or 1%), whereas a 70-year-old with a tumor that has 30 mm or greater CPA extension and absence of a fundal fluid cap has a predicted probability of NTR-STR of 0.91 (or 91%). Among the 171 patients who underwent NTR-STR, 24 required secondary treatment at the time of last follow-up.
CONCLUSION: The primary predictors of incomplete microsurgical resection of VS include older age at surgery, larger linear tumor size, and absence of a fundal fluid cap. These factors can be used to estimate the likelihood of NTR-STR, aiding in preoperative discussions regarding future surveillance and potential need of secondary treatment, as well as shared clinical decision making.