Optimal Timing of Primary Radiosurgical Treatment of Growing Vestibular Schwannoma: Insights From Salvage Microsurgery Outcomes.
Document Type
Article
Publication Date
5-1-2025
Publication Title
Otolaryngology and head and neck surgery
Abstract
OBJECTIVE: Limited evidence guides the optimal timing of treatment after the detection of tumor growth during the observation of sporadic vestibular schwannoma (VS). The current work aimed to inform the timing of radiosurgical intervention based on an analysis of patient outcomes among those who ultimately failed stereotactic radiosurgery (SRS) and underwent salvage microsurgery.
STUDY DESIGN: A historical cohort study.
SETTING: Seven centers across the United States and Norway.
METHODS: Adults with sporadic VS who underwent salvage microsurgery following failed primary SRS were included. The primary outcome of interest was the association between tumor size at the time of primary SRS and the ability to achieve gross total resection (GTR) and maintain postoperative House-Brackmann (HB) facial nerve grade I at the last follow-up after salvage microsurgery.
RESULTS: Among 96 patients, the median (interquartile range [IQR]) cerebellopontine angle (CPA) tumor size at primary SRS was 14.5 mm (10.0-19.0). Each 1-mm increase in CPA tumor size at the time of primary SRS was associated with a 13% increased likelihood of near-total/subtotal resection or most recent postoperative HB grade >I (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05-1.21, P = .001), with an optimal tumor size threshold to distinguish this outcome of 12 mm of CPA extension (c-index 0.73). Similarly, for each 1-mm increase in CPA tumor size at the time of primary SRS, a 9% increase in any postoperative complication with salvage microsurgery was observed (OR 1.09, 95% CI 1.02-1.15, P = .009).
CONCLUSION: Corroborated by size threshold surveillance data informing the timing of primary microsurgical resection, the current study suggests that VS outcomes are optimized when primary radiosurgical intervention is undertaken on growing tumors when they harbor 10-15 mm of cerebellopontine angle extension or less.
Volume
172
Issue
5
First Page
1717
Last Page
1724
Recommended Citation
Marinelli JP, Herberg HA, Moore LS, Yancey KL, Kay-Rivest E, Casale GG, Durham A, Khandalavala KR, Lund-Johansen M, Kosaraju N, Lohse CM, Patel NS, Gurgel RK, Babu SC, Golfinos JG, Roland JT, Hunter JB, Kutz JW, Santa Maria PL, Link MJ, Tveiten ØV, Carlson ML. Optimal Timing of Primary Radiosurgical Treatment of Growing Vestibular Schwannoma: Insights From Salvage Microsurgery Outcomes. Otolaryngol Head Neck Surg. 2025 May;172(5):1717-1724. doi: 10.1002/ohn.1161. Epub 2025 Feb 10. PMID: 39927827.
DOI
10.1002/ohn.1161
ISSN
1097-6817
PubMed ID
39927827