Purpose The aim of this study is to compute and validate a statistical predictive model for the risk of recurrence, defined as regrowth of tumor necessitating salvage treatment, after... Show morePurpose The aim of this study is to compute and validate a statistical predictive model for the risk of recurrence, defined as regrowth of tumor necessitating salvage treatment, after translabyrinthine removal of vestibular schwannomas to individualize postoperative surveillance. Methods The multivariable predictive model for risk of recurrence was based on retrospectively collected patient data between 1995 and 2017 at a tertiary referral center. To assess for internal validity of the prediction model tenfold cross-validation was performed. A 'low' calculated risk of recurrence in this study was set at < 1%, based on clinical criteria and expert opinion. Results A total of 596 patients with 33 recurrences (5.5%) were included for analysis. The final prediction model consisted of the predictors 'age at time of surgery', 'preoperative tumor growth' and 'first postoperative MRI outcome'. The area under the receiver operating curve of the prediction model was 89%, with a C-index of 0.686 (95% CI 0.614-0.796) after cross-validation. The predicted probability for risk of recurrence was low (< 1%) in 373 patients (63%). The earliest recurrence in these low-risk patients was detected at 46 months after surgery. Conclusion This study presents a well-performing prediction model for the risk of recurrence after translabyrinthine surgery for vestibular schwannoma. The prediction model can be used to tailor the postoperative surveillance to the estimated risk of recurrence of individual patients. It seems that especially in patients with an estimated low risk of recurrence, the interval between the first and second postoperative MRI can be safely prolonged. Show less
Objective: To identify predictors of tumor recurrence and postoperative facial nerve function after translabyrinthine surgery for unilateral vestibular schwannomas. Study Design: Retrospective... Show moreObjective: To identify predictors of tumor recurrence and postoperative facial nerve function after translabyrinthine surgery for unilateral vestibular schwannomas. Study Design: Retrospective study. Setting: Tertiary referral center. Patients: Between 1996 and 2017 a total of 596 patients with unilateral vestibular schwannoma underwent translabyrinthine surgery. Pre- and postoperative clinical status, radiological, and surgical findings were evaluated. Intervention(s): Translabyrinthine surgery. Main Outcome Measure(s): Potential predictors for tumor recurrence and facial nerve outcome were analyzed using Cox regression and ordinal logistic regression, respectively. Results: The extent of tumor removal was total in 32%, near-total in 58%, and subtotal in 10%. In 5.5% (33/596) of patients the tumor recurred. Subtotal tumor resection (p = 0.004, hazard ratios [HR] = 10.66), a young age (p = 0.008, HR = 0.96), and tumor progression preoperatively (p = 0.042, HR = 2.32) significantly increased the risk of recurrence, whereas tumor size or histologic composition did not. A good postoperative facial nerve function (House-Brackmann grade 1-2) was achieved in 85%. The risk of postoperative facial nerve paresis or paralysis increased with tumor size (p < 0.001, OR = 1.52), but was not associated with the extent of tumor removal, histologic composition, or patient demographics. Conclusions: Translabyrinthine surgery is an effective treatment for vestibular schwannoma, with a good local control rate and facial nerve outcome. The extent of tumor removal is a clinically relevant predictor for tumor recurrence, as are young patient age and preoperative tumor progression. A large preoperative tumor size is associated with a higher risk of postoperative facial nerve paresis or paralysis. Show less
Vestibular schwannomas are benign intracranial tumors which generally arise from the Schwann cells of the superior part of the vestibular portion of the eight cranial nerve. The most common... Show moreVestibular schwannomas are benign intracranial tumors which generally arise from the Schwann cells of the superior part of the vestibular portion of the eight cranial nerve. The most common symptoms accompanying vestibular schwannoma (VS) are unilateral hearing loss, tinnitus, vertigo and unsteadiness. For many years, microsurgical treatment of VS has been considered the __gold standard__. However, the treatment of VS continues to evolve with the advent of alternative treatment options such as wait and scan and stereotactic irradiation. Moreover, advances in MRI techniques have allowed for an early diagnosis and exact measurement of growth, which has led to an increased number of patients with small and minimally symptomatic tumors. As a result, the treatment of VS no longer involves life saving surgery, but prophylactic management of future morbidity. These developments have also created new insights into how vestibular schwannoma can be best treated, as it has become clear that the tumor may remain unchanged for many years. However, the treatment of VS patients still remains a matter of debate with advocates and opponents of each modality. Traditionally, the evaluation of VS treatment was performed using primary outcome measures such as mortality and morbidity. But the subject of quality of life (QoL) has increasingly become an important outcome measure in VS. QoL may provide clinicians valuable informati on that is not always Show less
