Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section.

Details

Serval ID
serval:BIB_E36EF0FC9B57
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section.
Journal
Acta neurochirurgica
Author(s)
Starnoni D., Giammattei L., Cossu G., Link M.J., Roche P.H., Chacko A.G., Ohata K., Samii M., Suri A., Bruneau M., Cornelius J.F., Cavallo L., Meling T.R., Froelich S., Tatagiba M., Sufianov A., Paraskevopoulos D., Zazpe I., Berhouma M., Jouanneau E., Verheul J.B., Tuleasca C., George M., Levivier M., Messerer M., Daniel R.T.
ISSN
0942-0940 (Electronic)
ISSN-L
0001-6268
Publication state
Published
Issued date
29/07/2020
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: aheadofprint
Abstract
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.
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.
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.
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.
Keywords
Combined management, Gross total resection, Large vestibular schwannoma, Microsurgery, Radiosurgery, Subtotal resection
Pubmed
Web of science
Open Access
Yes
Create date
13/08/2020 9:16
Last modification date
31/08/2020 6:26
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