Comparison of Surgical Outcomes and Recurrence Rates of Cystic and Solid Vestibular Schwannomas

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

Publication History

Received: 11 June 2019

Accepted: 08 August 2019

Article published online:
21 October 2019

• References

• 1 Metwali H, Samii M, Samii A, Gerganov V. The peculiar cystic vestibular schwannoma: a single-center experience. World Neurosurg 2014; 82 (06) 1271-1275
• 2 Sinha S, Sharma BS. Cystic acoustic neuromas: surgical outcome in a series of 58 patients. J Clin Neurosci 2008; 15 (05) 511-515
• 3 Yashar P, Zada G, Harris B, Giannotta SL. Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature. Neurosurg Focus 2012; 33 (03) E13
• 4 Piccirillo E, Wiet MR, Flanagan S. et al. Cystic vestibular schwannoma: classification, management, and facial nerve outcomes. Otol Neurotol 2009; 30 (06) 826-834
• 5 Jian BJ, Sughrue ME, Kaur R. et al. Implications of cystic features in vestibular schwannomas of patients undergoing microsurgical resection. Neurosurgery 2011; 68 (04) 874-880 , discussion 879–880
• 6 Park CK, Kim DC, Park SH. et al. Microhemorrhage, a possible mechanism for cyst formation in vestibular schwannomas. J Neurosurg 2006; 105 (04) 576-580
• 7 Charabi S, Klinken L, Tos M, Thomsen J. Histopathology and growth pattern of cystic acoustic neuromas. Laryngoscope 1994; 104 (11 Pt 1): 1348-1352
• 8 Moon KS, Jung S, Seo SK. et al. Cystic vestibular schwannomas: a possible role of matrix metalloproteinase-2 in cyst development and unfavorable surgical outcome. J Neurosurg 2007; 106 (05) 866-871
• 9 Lunardi P, Missori P, Mastronardi L, Fortuna A. Cystic acoustic schwannomas. Acta Neurochir (Wien) 1991; 110 (3-4): 120-123
• 10 Kameyama S, Tanaka R, Kawaguchi T, Fukuda M, Oyanagi K. Cystic acoustic neurinomas: studies of 14 cases. Acta Neurochir (Wien) 1996; 138 (06) 695-699
• 11 Benech F, Perez R, Fontanella MM, Morra B, Albera R, Ducati A. Cystic versus solid vestibular schwannomas: a series of 80 grade III-IV patients. Neurosurg Rev 2005; 28 (03) 209-213
• 12 de Ipolyi AR, Yang I, Buckley A, Barbaro NM, Cheung SW, Parsa AT. Fluctuating response of a cystic vestibular schwannoma to radiosurgery: case report. Neurosurgery 2008; 62 (05) E1164-E1165 , discussion E1165
• 13 Ganslandt O, Fahrig A, Strauss C. Hemorrhage into cystic vestibular schwannoma following stereotactic radiation therapy. Zentralbl Neurochir 2008; 69 (04) 204-206
• 14 Shirato H, Sakamoto T, Takeichi N. et al. Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): comparison between cystic-type and solid-type VS. Int J Radiat Oncol Biol Phys 2000; 48 (05) 1395-1401
• 15 Pendl G, Ganz JC, Kitz K, Eustacchio S. Acoustic neurinomas with macrocysts treated with Gamma Knife radiosurgery. Stereotact Funct Neurosurg 1996; 66 (Suppl. 01) 103-111
• 16 Gomez-Brouchet A, Delisle MB, Cognard C. et al. Vestibular schwannomas: correlations between magnetic resonance imaging and histopathologic appearance. Otol Neurotol 2001; 22 (01) 79-86
• 17 Muzumdar DP, Goel A, Pakhmode CK. Multicystic acoustic neurinoma: report of two cases. J Clin Neurosci 2002; 9 (04) 453-455