Abstract
Objective Cystic vestibular schwannomas (CVSs) are anecdotally believed to have worse clinical
and tumor-control outcomes than solid vestibular schwannomas (SVSs); however, no data
have been reported to support this belief. In this study, we characterize the clinical
outcomes of patients with CVSs versus those with SVSs.
Design This is a retrospective review of prospectively collected data.
Setting This study is set at single high-volume neurosurgical institute.
Participants We queried a database for details on all patients diagnosed with vestibular schwannomas
between January 2009 and January 2014.
Main Outcome Measures Records were retrospectively reviewed and analyzed using univariate and multivariate
analyses to study the differences in clinical outcomes and tumor progression or recurrence.
Results Of a total of 112 tumors, 24% (n = 27) were CVSs and 76% (n = 85) were SVSs. Univariate analysis identified the extent of resection, Koos grade,
and tumor diameter as significant predictors of recurrence (p ≤ 0.005). However, tumor diameter was the only significant predictor of recurrence
in the multivariate analysis (p = 0.007). Cystic change was not a predictor of recurrence in the univariate or multivariate
analysis (p ≥ 0.40). Postoperative facial nerve and hearing outcomes were similar for both CVSs
and SVSs (p ≥ 0.47).
Conclusion Postoperative facial nerve outcome, hearing, tumor progression, and recurrence are
similar for patients with CVSs and SVSs. As CVS growth patterns and responses to radiation
are unpredictable, we favor microsurgical resection over radiosurgery as the initial
treatment. Our data do not support the commonly held belief that cystic tumors behave
more aggressively than solid tumors or are associated with increased postoperative
facial nerve deficits.
Keywords
acoustic neuroma - facial nerve - hearing - preservation - microsurgical resection
- stereotactic radiosurgery - vestibular schwannoma
