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Acta Neurochirurgica

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Open Access 01-05-2020 | Vestibular Schwannoma | Original Article - Tumor - Schwannoma

The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery

Authors: Johannes Wach, Simon Brandecker, Agi Güresir, Patrick Schuss, Hartmut Vatter, Erdem Güresir

Published in: Acta Neurochirurgica | Issue 5/2020

Abstract

Background

Facial nerve palsy is a severe morbid condition that occurs after vestibular schwannoma (VS) surgery. The objective of this study was to evaluate facial nerve outcomes based on surgical techniques, tumour size, and immunohistochemical factors.

Methods

One hundred eighteen patients with VS were retrospectively analysed. Gross total resection (GTR) was achieved in 83 patients, and subtotal resection (STR) was achieved in 35 patients. Follow-up was 60 months (median). Facial nerve outcomes were assessed for 24 months after surgery. Analysis of the MIB-1 index was performed in 114 patients (97%) to evaluate recurrence and facial nerve outcomes.

Results

Immediately after surgery, 16 of 35 patients (45.7%) with STR and 21 of 83 patients (25.3%) with GTR had a good (House-Brackmann (HB) score ≤ 2) facial nerve outcome (p = 0.029). Semi-sitting positioning (p = 0.002) and tumour size class of 3 (> 4 cm) were also associated with worse HB outcomes after 2 years (p = 0.004) in univariate analyses. The MIB-1 index was significantly correlated with diffuse infiltration of tumour-associated CD45⁺ lymphocytes (r = 0.63, p = 0.015) and CD68⁺ macrophages (r = 0.43, p = 0.021). ROC analysis found an AUC of 0.73 (95% CI = 0.60–0.86, p = 0.003) for the MIB-1 index in predicting poor facial nerve outcomes. Binary logistic regression analysis revealed an MIB-1 index ≥ 5% (16/28 (57.1%) vs. 5/40 (12.5%); p < 0.001, OR = 14.0, 95% CI = 3.2–61.1) and a tumour size class of 3 (6/8 (75.0%) vs. 2/8 (25.0%); p = 0.01, OR = 14.56, 95% CI = 1.9–113.4) were predictors of poor HB scores (≥ 3) after 1 year.

Conclusions

An MIB-1 index ≥ 5% seems to predict worse long-term facial nerve outcomes in VS surgery.

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Title: The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery
Authors: Johannes Wach
Simon Brandecker
Agi Güresir
Patrick Schuss
Hartmut Vatter
Erdem Güresir
Publication date: 01-05-2020
Publisher: Springer Vienna
Keywords: Vestibular Schwannoma
Vestibular Schwannoma
Published in: Acta Neurochirurgica / Issue 5/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04283-z

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The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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