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Recurrence of vestibular schwannoma after gross total, near total and subtotal microsurgical resection
Author(s): ,
T. Van Havenbergh
Affiliations:
GZA Hospitals, skull base team, Antwerp, Belgium
,
T. Somers
Affiliations:
GZA Hospitals, skull base team, Antwerp, Belgium
,
P. Van Loo
Affiliations:
GZA Hospitals, neurosurgery, Antwerp, Belgium
,
R. Van Paesschen
Affiliations:
GZA Hospitals, neurosurgery, Antwerp, Belgium
,
K. De Smedt
Affiliations:
GZA Hospitals, neurosurgery, Antwerp, Belgium
D. Berghmans
Affiliations:
GZA Hospitals, neurosurgery, Antwerp, Belgium
EANS Academy. Van Havenbergh T. Oct 21, 2018; 225809; EP4123
Dr. Tony Van Havenbergh
Dr. Tony Van Havenbergh
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Abstract
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Background
With the availability of radiosurgery the surgical treatment of vestibular schwannomas (VS) is restricted to larger lesions. These are the challenging cases for facial nerve function preservation. Some advocate deliberate subtotal resection. In our department, the policy is to resect the tumor maximally unless facial function is at risk during the procedure. In our series we looked for recurrences and the relation to gross total, (GT) near total (NT) or subtotal resection (ST).

Methods
We analysed the charts of 140 patients undergoing microsurgical resection of a VS with a minimal follow up of 2 years. All patients had immediate postoperative MRI and a regular follow up by MRI after 1, and every 3 years in case of GT resection, and every year in case of NT or ST resection . We looked for facial nerve function (House Brackman: HB) and tumor recurrence.

Results
The mean follow up was 4,3 years. There were 121 patients with GT, 11 with ST and 8 with NT resection. In the group of GT resections we had 2 recurrences (1,6%) at 2,5 and 4 years with a mean follow up of this group of 4,2 years. 92% of patients had a good facial function (HB grade I-II). In the NT group there were no recurrences (0%) with a mean follow up 4,5 years. In 5 patients facial function was good. In the ST group we saw growth of the residual tumor in 6 out of 11 cases (55%). In this group the mean follow up was 4,4 years. Facial function was good in 67%.

Conclusions
The recurrence rate after gross total or near total resection of large vestibular schwannomas is low. In case of subtotal resection the regrowth rate is high, implicating that adjuvant radiosurgery in these cases is to be advised.
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