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Open Access 01-11-2020 | Vestibular Schwannoma | Review Article - Tumor - Schwannoma

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

Authors: Daniele Starnoni, Lorenzo Giammattei, Giulia Cossu, Michael J. Link, Pierre-Hugues Roche, Ari G. Chacko, Kenji Ohata, Majid Samii, Ashish Suri, Michael Bruneau, Jan F. Cornelius, Luigi Cavallo, Torstein R. Meling, Sebastien Froelich, Marcos Tatagiba, Albert Sufianov, Dimitrios Paraskevopoulos, Idoya Zazpe, Moncef Berhouma, Emmanuel Jouanneau, Jeroen B. Verheul, Constantin Tuleasca, Mercy George, Marc Levivier, Mahmoud Messerer, Roy Thomas Daniel

Published in: Acta Neurochirurgica | Issue 11/2020

Abstract

Background and objective

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.

Material and methods

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.

Results

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.

Conclusion

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.

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Title: Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section
Authors: Daniele Starnoni
Lorenzo Giammattei
Giulia Cossu
Michael J. Link
Pierre-Hugues Roche
Ari G. Chacko
Kenji Ohata
Majid Samii
Ashish Suri
Michael Bruneau
Jan F. Cornelius
Luigi Cavallo
Torstein R. Meling
Sebastien Froelich
Marcos Tatagiba
Albert Sufianov
Dimitrios Paraskevopoulos
Idoya Zazpe
Moncef Berhouma
Emmanuel Jouanneau
Jeroen B. Verheul
Constantin Tuleasca
Mercy George
Marc Levivier
Mahmoud Messerer
Roy Thomas Daniel
Publication date: 01-11-2020
Publisher: Springer Vienna
Keywords: Vestibular Schwannoma
Vestibular Schwannoma
Published in: Acta Neurochirurgica / Issue 11/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04491-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Background and objective

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background and objective

Material and methods

Results

Conclusion

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