TY - JOUR
T1 - Surgical management for large vestibular schwannomas
T2 - a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section
AU - Starnoni, Daniele
AU - Giammattei, Lorenzo
AU - Cossu, Giulia
AU - Link, Michael J
AU - Roche, Pierre-Hugues
AU - Chacko, Ari G
AU - Ohata, Kenji
AU - Samii, Majid
AU - Suri, Ashish
AU - Bruneau, Michael
AU - Cornelius, Jan F
AU - Cavallo, Luigi
AU - Meling, Torstein R
AU - Froelich, Sebastien
AU - Tatagiba, Marcos
AU - Sufianov, Albert
AU - Paraskevopoulos, Dimitrios
AU - Zazpe, Idoya
AU - Berhouma, Moncef
AU - Jouanneau, Emmanuel
AU - Verheul, Jeroen B
AU - Tuleasca, Constantin
AU - George, Mercy
AU - Levivier, Marc
AU - Messerer, Mahmoud
AU - Daniel, Roy Thomas
PY - 2020/11
Y1 - 2020/11
N2 - BACKGROUND AND OBJECTIVE: The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective.MATERIAL AND METHODS: A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management.RESULTS: Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed.CONCLUSION: The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
AB - BACKGROUND AND OBJECTIVE: The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective.MATERIAL AND METHODS: A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management.RESULTS: Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed.CONCLUSION: The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
KW - Combined management
KW - Gross total resection
KW - Large vestibular schwannoma
KW - Microsurgery
KW - Radiosurgery
KW - Subtotal resection
U2 - 10.1007/s00701-020-04491-7
DO - 10.1007/s00701-020-04491-7
M3 - Article
C2 - 32728903
VL - 162
SP - 2595
EP - 2617
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 11
ER -