The fate of the tumor remnant after less-than-complete acoustic neuroma resection
| Autor: | John S. Oghalai, Robert K. Jackler, Dov C Bloch, Monica R Osofsky, Lawrence H. Pitts |
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| Rok vydání: | 2004 |
| Předmět: |
Adult
medicine.medical_specialty Neoplasm Residual Acoustic neuroma Risk Assessment Resection 03 medical and health sciences 0302 clinical medicine Chart review medicine Humans Tumor growth Single scan 030223 otorhinolaryngology Aged Retrospective Studies Aged 80 and over Surgical approach business.industry Subtotal Resection Neuroma Acoustic Middle Aged medicine.disease Middle fossa Surgery Otorhinolaryngologic Surgical Procedures Otorhinolaryngology 030220 oncology & carcinogenesis Neoplasm Recurrence Local business |
| Zdroj: | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 130(1) |
| ISSN: | 0194-5998 |
| Popis: | We sought to determine the recurrence rate after near-total and subtotal resection of acoustic neuroma.We conducted a retrospective chart review of a total of 79 patients: 50 with near-total resections (remnantor =25 mm(2) andor =2 mm thick) and 29 with subtotal resections (any larger remnant). Surgical approach included 5 middle fossa, 17 retrosigmoid, and 57 translabyrinthine.Recurrence was defined as documented tumor growth by serial imaging or the recommendation for further treatment after a single scan. No recurrence was defined as no visible tumor on imaging for a minimum follow-up time of 3 years or tumor remnants that remained unchanged on serial scans (mean, 5-year follow-up).Fifty-two patients were included in the study group. Recurrences were seen in 1 (3%) of 33 patients who had a near-total resection compared with 6 (32%) of 19 patients who had a subtotal resection. After adjustment for follow-up time and large tumor size, the odds ratio for recurrence was 12 times larger for subtotal than for near-total resections (P = 0.033). All recurrences were seen following the translabyrinthine approach in the mid-cerebellopontine angle. None were encountered in the internal auditory canal. The mean time interval from surgery to the detection of a recurrence was 3 years (range, 1 to 5 years).The recurrence rate when performing a near-total resection is low but is substantially higher with a subtotal resection. Recurrences can be detected within the first 5 postoperative years. We recommend near-total resection in any patient if needed to preserve neural integrity. Subtotal resection is best avoided whenever possible; however, adjunctive treatment with stereotactic radiotherapy may be considered. |
| Databáze: | OpenAIRE |
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