Should partial removal followed by SRS be scheduled in vestibular schwannomas?
EANS Academy. Seo Y. 09/25/19; 275388; EP04031
Dr. Yoshinobu Seo
Dr. Yoshinobu Seo

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Background: It is controversial how to manage vestibular schwannomas, even how much should be surgically removed. Scheduled SRS is recommended by some authors. It is, however, increases economic and invasive burden to patients. We assess whether scheduled SRS after craniotomy is really profitable in management of vestibular schwannomas.
Methods: Seventy-four cases underwent craniotomy from 2006 through 2017. Of 74, 10 cases were excluded because of less than 2-year follow-up. Patients were divided into 2 groups. Group A was defined as cases without removal of the posterior wall of the IAC and were supposed to undergo scheduled SRS after surgery, and Group B was defined with deletion of the posterior wall of the IAC without scheduled SRS. Facial and hearing function were compared between Group A and B.
Results: Fourteen cases of 22 (63.6%) underwent SRS after craniotomy in Group A. Of 22 cases, 5 were scheduled SRS. On the other hand, 6 of 42 (14.3%) underwent SRS and 3 were scheduled. Facial function was preserved in 21 of 22 (95.5%) in Group A and 42 of 42 (100%) in Group B. Useful hearing function was preserved in 4 of 9 (44.4%) in Group A and 5 of 11 (45.5%) in Group B. Two patients acquired useful hearing ability from unuseful hearing ability in Group A. There was no significant difference of facial and hearing function at the last follow-up between Group A and B.
Conclusions: The functional results with deletion of the posterior wall of the IAC and subtotal removal of the tumor were as good as those without deletion of the posterior wall of the IAC followed by supposed scheduled SRS. As scheduled SRS influences much more both economically and invasion to the body, it is better not to plan scheduled SRS after craniotomy.
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