Outcomes in Vestibular Schwannoma Treated with Primary Microsurgery: Clinical Landscape
Bibliographic record
Abstract
Objective: Vestibular schwannoma (VS) is the most common tumor of the cerebellopontine angle. Owing to complex anatomy and high rates of morbidity, surgical management of large tumors is challenging. In this study, we seek to explore the clinical landscape of VS in order to identify predictors of outcome and help guide surgical decision making. Methods: We retrospectively reviewed charts of patients who underwent surgery as the initial treatment modality for VS between 2005 and 2020 at a quaternary referral center in Toronto, Canada. Mined data includes patient demographics, clinical presentation, radiological features, and treatment details. Regression modeling was used to identify predictors of tumor control, postoperative morbidity, and correlates of progression free survival (PFS). Results: Two hundred and five tumors, all of which underwent initial operative treatment and contained sufficient data for meaningful analysis, were included in our study. Syndromic NF2, larger tumors (>3 cm), subtotal resection (as compared to gross-total resection), presence of edema on preoperative MRI, and preoperative trigeminal symptoms were all predictors of postoperative progression/recurrence or need for further treatment, and the latter four were also significant correlates of a shorter progression free survival ([ Fig. 1A ]). Extent of resection (EOR), tumor size, and Koos’ grade were independently predictive of postoperative progression/recurrence or secondary intervention in multivariate models; however, only EOR was independently predictive of progression-free survival ([ Fig. 1B ]). EOR, tumor size, and patient age are each independently predictive of facial nerve outcome. A small group of Koos’ grade 4 tumors were treated with subtotal resection and planned adjuvant radiotherapy ( n = 5); all experienced tumor control with minimal morbidity. Conclusion: We comprehensively explore the clinical landscape of surgically treated vestibular schwannoma and find extent of resection to be significantly associated with tumor control and facial nerve dysfunction in large tumors. Additional correlates of key outcome measures include preoperative trigeminal symptoms, preoperative edema, and tumor size. This may have important implications in risk stratifying these challenging cases. Fig. 1 Kaplan Meier curves of progression/recurrence. An event is defined as progression after initial surgery, without intervening therapy. ( A ) Univariate Kaplan Meier curves of preoperative edema on MRI, EOR, preoperative trigeminal dysfunction, and preoperative size. ( B ) Effect of EOR on PFS, stratified by preoperative edema (top), preoperative trigeminal symptoms (middle), and preoperative size (bottom). Publication History Article published online: 15 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".