The relationship between extent of resection, tumor recurrence, and facial nerve outcomes in vestibular schwannoma surgery: a single-institution experience and systematic review.

BACKGROUND: Gross surgical resection (GTR) of vestibular schwannomas (VS) is curative, but how surgical intent translates to facial nerve outcomes in practice, however, is incompletely understood. The purpose of this study was to identify factors predicting tumor recurrence in our contemporary VS cohort and explore existing literature regarding extent of resection and facial nerve outcomes. METHODS: In this retrospective study, we reviewed outcomes for 451 VS patients who underwent surgical resection at our institution between July 2016 and April 2024. We collected data on demographics, intraoperative clinical characteristics, and postoperative outcomes. A systematic review of all existing VS literature was conducted to compare rates of GTR to rates of preserved facial nerve function. RESULTS: A multivariable analysis found that larger tumor size increased the risk of recurrence [hazard ratio (HR): 1.903, 95% confidence interval (CI): 1.163-3.113, p = 0.010] and GTR decreased the risk of recurrence (HR: 0.022, 95% CI: 0.003-0.169, p < 0.001). Additionally, a systematic analysis of data extracted from 75 VS studies showed an inverse relationship between rate of GTR and good facial nerve outcomes, but only in series that reported a rate of at least 75% GTR. CONCLUSION: Our data indicate that the risk of tumor recurrence decreases with GTR. Using rate of GTR as a surrogate for surgical intent in institutional studies, we found that the rate of GTR correlates with facial nerve outcomes only in the most surgically aggressive series. Overall, these data support a strategy individualized to each patient that is refined based on intraoperative findings.

Duke Scholars

Author Howard Wayne Francis Otology, Neurotology & Skull Base Surgery