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Significant tumor compression of the middle cerebellar peduncle is associated with worse facial nerve outcomes and lower extent of resection in surgery for medium-sized vestibular schwannomas – A radiographic analysis of a case series.
Tai et al., Clin Neurol Neurosurg 2024
DOI: 10.1016/j.clineuro.2024.108114
New Findings:
The study introduces the degree of compression on the middle cerebellar peduncle (PC) as a predictive factor for facial nerve outcomes (FNO) and extent of resection (EOR) in medium-sized vestibular schwannomas (VS), which has not been consistently reported before.
Importance:
This research provides a new preoperative imaging metric that can help predict surgical outcomes for patients with medium-sized VS, potentially guiding surgical planning and patient counseling.
Contribution to Literature:
Previously, tumor size was the primary predictive factor for FNO and EOR. This study adds the degree of PC compression as an additional, significant predictor for these outcomes in medium-sized VS.
Results Summary:
– Patients with unfavorable immediate post-op FNO had a greater PC (19.9 mm) compared to those with favorable outcomes (15.4 mm, P = .047).
– In medium-sized tumors, significant differences in PC were found between patients with unfavorable and favorable FNO both immediately post-op (14.1 mm vs. 8.7 mm) and at last follow-up.
– Subtotal resections were associated with greater PC (20.7 mm) compared to near-total (14.3 mm) and gross total resections (10.8 mm).
– Multivariate analyses confirmed the predictive value of PC in medium-sized tumors, but not in large-sized tumors.
Conclusion:
For medium-sized VS, a PC measurement of >15 mm on preoperative imaging is likely indicative of worse FNO and lower EOR, making it a valuable factor for surgical consideration.