Facial Nerve Outcomes After Vestibular Schwannoma Microsurgical Resection in Neurofibromatosis Type 2

Objective The aim of this study is to investigate facial nerve outcomes after microsurgical resection in neurofibromatosis type 2 (NF2) compared to sporadic tumors. Study Design Single institutional retrospective chart review. Setting Tertiary referral center. Methods All adult patients with NF2 vestibular schwannoma (VS) or sporadic VS who underwent microsurgical resection from 2008 to 2019 with preoperative magnetic resonance imaging (MRI) and 1 year of postsurgical follow-up were included. The primary outcome measure was postoperative House-Brackmann (HB) facial nerve score measured at first postoperative visit and after at least 10 months. Results In total, 161 sporadic VSs and 14 NF2 VSs met inclusion criteria. Both median tumor diameter (NF2, 33.5 mm vs sporadic, 24 mm, P = .0011) and median tumor volume (NF2, 12.4 cm3 vs sporadic, 2.9 cm3, P = .0005) were significantly greater in patients with NF2. The median follow-up was 24.9 months (range, 12-130.1). Median facial nerve function after 1 year for patients with NF2 was HB 3 (range, 1-6) compared to HB 1 (range, 1-6) for sporadic VS (P = .001). With multivariate logistic regression, NF2 tumors (odds ratio [OR] = 13.9, P = .001) and tumor volume ≥3 cm3 (OR = 3.6, P = .025) were significantly associated with HB ≥3 when controlling for age, sex, extent of tumor resection, translabyrinthine approach, and prior radiation. Conclusion Tumor volume >3 cm3 and NF2 tumors are associated with poorer facial nerve outcomes 1 year following microsurgical resection.

[1]  Y. Temel,et al.  Therapy of Sporadic and NF2-Related Vestibular Schwannoma , 2020, Cancers.

[2]  J. Régis,et al.  Does NF2 status impact the results of combined surgery and adjunctive Gamma Knife surgery for large vestibular schwannomas? , 2019, Neurosurgical review.

[3]  H. Seol,et al.  Prognostic factors of facial nerve function after vestibular schwannoma removal via translabyrinthine approach , 2019, Acta oto-laryngologica.

[4]  Maura K. Cosetti,et al.  Management of Vestibular Schwannoma (Including NF2): Facial Nerve Considerations. , 2018, Otolaryngologic clinics of North America.

[5]  R. Foley.  Acoustic neuroma quality of life: are we missing the point? , 2018, European Archives of Oto-Rhino-Laryngology.

[6]  C. Lohse,et al.  Incidence of Vestibular Schwannoma over the Past Half-Century: A Population-Based Study of Olmsted County, Minnesota , 2018, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[7]  P. Li,et al.  Surgical treatment of large vestibular schwannomas in patients with neurofibromatosis type 2: outcomes on facial nerve function and hearing preservation , 2018, Journal of Neuro-Oncology.

[8]  M. McCabe,et al.  An update on the diagnosis and treatment of vestibular schwannoma , 2018, Expert review of neurotherapeutics.

[9]  M. Javadpour,et al.  Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis , 2017, Cureus.

[10]  J. Leonetti,et al.  Prognostic Indices for Predicting Facial Nerve Outcome following the Resection of Large Acoustic Neuromas , 2017, Journal of Neurological Surgery Part B: Skull Base.

[11]  C. Lohse,et al.  Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma. , 2016, Journal of neurosurgery.

[12]  E. Ferrary,et al.  Multivariate Analysis of Factors Influencing Facial Nerve Outcome following Microsurgical Resection of Vestibular Schwannoma , 2017, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[13]  J. Zevallos,et al.  Diagnostic Criteria for Detection of Vestibular Schwannomas in the VA Population , 2016, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[14]  A. Friedman,et al.  Microsurgical resection of vestibular schwannomas: complication avoidance , 2016, Journal of Neuro-Oncology.

[15]  P. Theodosopoulos,et al.  Facial Nerve Outcome and Tumor Control Rate as a Function of Degree of Resection in Treatment of Large Acoustic Neuromas: Preliminary Report of the Acoustic Neuroma Subtotal Resection Study (ANSRS). , 2016, Neurosurgery.

[16]  A. Podgórska,et al.  Surgery for sporadic vestibular schwannoma. Part IV. Predictive factors influencing facial nerve function after surgery. , 2016, Neurologia i neurochirurgia polska.

[17]  Jamie J Van Gompel,et al.  The Changing Landscape of Vestibular Schwannoma Management in the United States—A Shift Toward Conservatism , 2015, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[18]  Jason K. Hsieh,et al.  Incidence of vestibular schwannomas in the United States , 2015, Journal of Neuro-Oncology.

[19]  Y. Ghavami,et al.  Vestibular Schwannoma Excision in Sporadic versus Neurofibromatosis Type 2 Populations , 2015, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[20]  F. Linthicum,et al.  Neurofibromatosis 2 Invasion of the Internal Auditory Canal Wall: Clinical Significance , 2014, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[21]  R. Sataloff,et al.  Acoustic Neuroma: An Investigation of Associations between Tumor Size and Diagnostic Delays, Facial Weakness, and Surgical Complications , 2014, Ear, nose, & throat journal.

[22]  I. Saliba,et al.  Neurofibromatosis Type 2 Vestibular Schwannoma Treatment: A Review of the Literature, Trends, and Outcomes , 2014, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[23]  R. Macfarlane,et al.  Factors affecting final facial nerve outcome following vestibular schwannoma surgery. , 2014, The Journal of laryngology and otology.

[24]  R. Kurzrock,et al.  NF2/Merlin in hereditary neurofibromatosis 2 versus cancer: biologic mechanisms and clinical associations , 2013, Oncotarget.

[25]  D. Evans,et al.  Outcome of translabyrinthine surgery for vestibular schwannoma in neurofibromatosis type 2 , 2013, British journal of neurosurgery.

[26]  Mayur Sharma,et al.  Radiological and Clinical Factors Predicting the Facial Nerve Outcome following Retrosigmoid Approach for Large Vestibular Schwannomas (VSs) , 2013, Journal of Neurological Surgery—Part B.

[27]  D. Evans,et al.  Neurofibromatosis type 2 (NF2): diagnosis and management. , 2013, Handbook of clinical neurology.

[28]  W. Shehata-Dieler,et al.  Outcome on hearing and facial nerve function in microsurgical treatment of small vestibular schwannoma via the middle cranial fossa approach , 2013, European Archives of Oto-Rhino-Laryngology.

[29]  R. Amdur,et al.  Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter? , 2012, Neurosurgical focus.

[30]  F. Raymond,et al.  Surgical Management of Vestibular Schwannomas and Hearing Rehabilitation in Neurofibromatosis Type 2 , 2012, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[31]  P. Cayé-Thomasen,et al.  Outcome after Translabyrinthine Surgery for Vestibular Schwannomas: Report on 1244 Patients , 2012, Journal of Neurological Surgery—Part B.

[32]  I. Yang,et al.  Preservation of facial nerve function after resection of vestibular schwannoma , 2010, British journal of neurosurgery.

[33]  L. Pitts,et al.  Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma , 2010, Journal of Neuro-Oncology.

[34]  A. Samii,et al.  Functional outcome after complete surgical removal of giant vestibular schwannomas. , 2010, Journal of neurosurgery.

[35]  D. Evans,et al.  Neurofibromatosis type 2 (NF2): A clinical and molecular review , 2009 .

[36]  L. Pitts,et al.  Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery , 2009, Journal of Neuro-Oncology.

[37]  D. Brackmann,et al.  Facial Nerve Function after Translabyrinthine Vestibular Schwannoma Surgery , 2007, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[38]  S. Lownie,et al.  Assessing impairment and disability of facial paralysis in patients with vestibular schwannoma. , 2007, Archives of otolaryngology--head & neck surgery.

[39]  A. Samii,et al.  Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. , 2006, Journal of neurosurgery.

[40]  J. Rubinstein,et al.  Small Acoustic Neuromas: Surgical Outcomes Versus Observation or Radiation , 2006, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[41]  V. Colletti,et al.  Middle Fossa Versus Retrosigmoid-Transmeatal Approach in Vestibular Schwannoma Surgery: A Prospective Study , 2003, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[42]  O. Sterkers,et al.  Predictive Factors of Long-term Facial Nerve Function after Vestibular Schwannoma Surgery , 2002, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[43]  L. Yardley,et al.  Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. , 2001, Journal of neurosurgery.

[44]  H. El-Kashlan,et al.  Recurrence of acoustic neuroma after incomplete resection. , 2000, The American journal of otology.

[45]  M. D. da Cruz,et al.  Postoperative Quality of Life in Vestibular Schwannoma Patients Measured by the SF36 Health Questionnaire , 2000, The Laryngoscope.

[46]  Gerald J. Ross,et al.  Acoustic Neuroma (Vestibular Schwannoma) , 1998 .

[47]  M. Samii,et al.  Management of vestibular schwannomas (acoustic neuromas): auditory and facial nerve function after resection of 120 vestibular schwannomas in patients with neurofibromatosis 2. , 1997, Neurosurgery.

[48]  M Samii,et al.  Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. , 1997, Neurosurgery.

[49]  J. W. House,et al.  Facial Nerve Grading System , 1985, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.