• Jonathan D Breshears, Ramin A Morshed, Annette M Molinaro, Michael W McDermott, Steven W Cheung, and Philip V Theodosopoulos.
• Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
• Neurosurgery. 2020 Mar 1; 86 (3): 410-416.

BackgroundPreservation of functional integrity during vestibular schwannoma surgery has become critical in the era of patient-centric medical decision-making. Subtotal tumor removal is often necessary when dense adhesions between the tumor and critical structures are present. However, it is unclear what the rate of tumor control is after subtotal resection (STR) and what factors are associated with recurrence.ObjectiveTo determine the rate of residual tumor growth after STR and identify clinical and radiographic predictors of tumor progression.MethodsA single-institution retrospective study was performed on all sporadic vestibular schwannomas that underwent surgical resection between January 1, 2002 and December 31, 2015. Clinical charts, pathology, radiology, and operative reports were reviewed. Volumetric analysis was performed on all pre- and postoperative MR imaging. Univariate and multivariate logistic regression was performed to identify predictors of the primary endpoint of tumor progression. Kaplan-Meier analysis was performed to compare progression free survival between 2 groups of residual tumor volumes and location.ResultsIn this cohort of 66 patients who underwent primary STR, 30% had documented progression within a median follow up period of 3.1 yr. Greater residual tumor volume (OR 2.0 [1.1-4.0]) and residual disease within the internal auditory canal (OR 3.7 [1.0-13.4]) predicted progression on multivariate analysis.ConclusionThese longitudinal data provide insight into the behavior of residual tumor, helping clinicians to determine if and when STR is an acceptable surgical strategy and to anchor expectations during shared medical decision-making consultation with patients.Copyright © 2019 by the Congress of Neurological Surgeons.

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