Comparing Outcomes Following Salvage Microsurgery in Vestibular Schwannoma Patients Failing Gamma-knife Radiosurgery or Microsurgery

Hyun Jin Lee, Mi Joo Kim, Seung Hyun Koh, Won Seok Chang, In Seok Moon

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: The increasing use of primary gamma-knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) has led to a concomitant increase in the number of patients requiring salvage surgery for GKS failure. When patients underwent GKS as the primary treatment, it is known that dissecting tumor from adjacent nerves during salvage surgery is more difficult. In this report, we share our clinical experience with such patients and analyze the clinical findings of patients with tumor regrowth/recurrence. Study Design: Retrospective chart review. Setting: Tertiary center. Patients: Nine patients who underwent salvage surgery for VS regrowth/recurrence after GKS or microsurgery were enrolled. Main Outcome Measures: Symptom progression, radiological changes, intraoperative findings, and surgical outcomes were evaluated and compared. Results: Six patients with previous GKS and three with previous microsurgery underwent salvage microsurgery. The most obvious symptom of tumor regrowth was aggravation of hearing loss. Salvage surgery in all patients was limited to subtotal or near-total resection via a translabyrinthine/transotic approach. Severe adhesion, thickening, and fibrosis were more prominent findings in the GKS than in the previous microsurgery group. Dissection of the tumor from the facial nerve was more difficult in the GKS than in the microsurgery patients. Despite anatomical preservation of the facial nerve in all the six patients, three in the GKS group, but none in the revision microsurgery group, had worsening of facial nerve function. Conclusion: Salvage microsurgery of VS after failed GKS is more difficult than revision microsurgery, and the facial nerve outcomes are relatively poor. Therefore, the primary method of VS treatment should be carefully chosen. Additional imaging studies are recommended in patients with a sudden change in hearing loss who underwent GKS.

Original languageEnglish
Pages (from-to)1339-1344
Number of pages6
JournalOtology and Neurotology
Volume38
Issue number9
DOIs
Publication statusPublished - 2017 Oct 1

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Acoustic Neuroma
Microsurgery
Radiosurgery
Facial Nerve
Hearing Loss
Neoplasms
Recurrence
Dissection
Fibrosis
Therapeutics
Retrospective Studies
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Cite this

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title = "Comparing Outcomes Following Salvage Microsurgery in Vestibular Schwannoma Patients Failing Gamma-knife Radiosurgery or Microsurgery",
abstract = "Objective: The increasing use of primary gamma-knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) has led to a concomitant increase in the number of patients requiring salvage surgery for GKS failure. When patients underwent GKS as the primary treatment, it is known that dissecting tumor from adjacent nerves during salvage surgery is more difficult. In this report, we share our clinical experience with such patients and analyze the clinical findings of patients with tumor regrowth/recurrence. Study Design: Retrospective chart review. Setting: Tertiary center. Patients: Nine patients who underwent salvage surgery for VS regrowth/recurrence after GKS or microsurgery were enrolled. Main Outcome Measures: Symptom progression, radiological changes, intraoperative findings, and surgical outcomes were evaluated and compared. Results: Six patients with previous GKS and three with previous microsurgery underwent salvage microsurgery. The most obvious symptom of tumor regrowth was aggravation of hearing loss. Salvage surgery in all patients was limited to subtotal or near-total resection via a translabyrinthine/transotic approach. Severe adhesion, thickening, and fibrosis were more prominent findings in the GKS than in the previous microsurgery group. Dissection of the tumor from the facial nerve was more difficult in the GKS than in the microsurgery patients. Despite anatomical preservation of the facial nerve in all the six patients, three in the GKS group, but none in the revision microsurgery group, had worsening of facial nerve function. Conclusion: Salvage microsurgery of VS after failed GKS is more difficult than revision microsurgery, and the facial nerve outcomes are relatively poor. Therefore, the primary method of VS treatment should be carefully chosen. Additional imaging studies are recommended in patients with a sudden change in hearing loss who underwent GKS.",
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Comparing Outcomes Following Salvage Microsurgery in Vestibular Schwannoma Patients Failing Gamma-knife Radiosurgery or Microsurgery. / Lee, Hyun Jin; Kim, Mi Joo; Koh, Seung Hyun; Chang, Won Seok; Moon, In Seok.

In: Otology and Neurotology, Vol. 38, No. 9, 01.10.2017, p. 1339-1344.

Research output: Contribution to journalArticle

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AU - Kim, Mi Joo

AU - Koh, Seung Hyun

AU - Chang, Won Seok

AU - Moon, In Seok

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N2 - Objective: The increasing use of primary gamma-knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) has led to a concomitant increase in the number of patients requiring salvage surgery for GKS failure. When patients underwent GKS as the primary treatment, it is known that dissecting tumor from adjacent nerves during salvage surgery is more difficult. In this report, we share our clinical experience with such patients and analyze the clinical findings of patients with tumor regrowth/recurrence. Study Design: Retrospective chart review. Setting: Tertiary center. Patients: Nine patients who underwent salvage surgery for VS regrowth/recurrence after GKS or microsurgery were enrolled. Main Outcome Measures: Symptom progression, radiological changes, intraoperative findings, and surgical outcomes were evaluated and compared. Results: Six patients with previous GKS and three with previous microsurgery underwent salvage microsurgery. The most obvious symptom of tumor regrowth was aggravation of hearing loss. Salvage surgery in all patients was limited to subtotal or near-total resection via a translabyrinthine/transotic approach. Severe adhesion, thickening, and fibrosis were more prominent findings in the GKS than in the previous microsurgery group. Dissection of the tumor from the facial nerve was more difficult in the GKS than in the microsurgery patients. Despite anatomical preservation of the facial nerve in all the six patients, three in the GKS group, but none in the revision microsurgery group, had worsening of facial nerve function. Conclusion: Salvage microsurgery of VS after failed GKS is more difficult than revision microsurgery, and the facial nerve outcomes are relatively poor. Therefore, the primary method of VS treatment should be carefully chosen. Additional imaging studies are recommended in patients with a sudden change in hearing loss who underwent GKS.

AB - Objective: The increasing use of primary gamma-knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) has led to a concomitant increase in the number of patients requiring salvage surgery for GKS failure. When patients underwent GKS as the primary treatment, it is known that dissecting tumor from adjacent nerves during salvage surgery is more difficult. In this report, we share our clinical experience with such patients and analyze the clinical findings of patients with tumor regrowth/recurrence. Study Design: Retrospective chart review. Setting: Tertiary center. Patients: Nine patients who underwent salvage surgery for VS regrowth/recurrence after GKS or microsurgery were enrolled. Main Outcome Measures: Symptom progression, radiological changes, intraoperative findings, and surgical outcomes were evaluated and compared. Results: Six patients with previous GKS and three with previous microsurgery underwent salvage microsurgery. The most obvious symptom of tumor regrowth was aggravation of hearing loss. Salvage surgery in all patients was limited to subtotal or near-total resection via a translabyrinthine/transotic approach. Severe adhesion, thickening, and fibrosis were more prominent findings in the GKS than in the previous microsurgery group. Dissection of the tumor from the facial nerve was more difficult in the GKS than in the microsurgery patients. Despite anatomical preservation of the facial nerve in all the six patients, three in the GKS group, but none in the revision microsurgery group, had worsening of facial nerve function. Conclusion: Salvage microsurgery of VS after failed GKS is more difficult than revision microsurgery, and the facial nerve outcomes are relatively poor. Therefore, the primary method of VS treatment should be carefully chosen. Additional imaging studies are recommended in patients with a sudden change in hearing loss who underwent GKS.

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