Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on beh
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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 Daniele Starnoni 1 & Lorenzo Giammattei 2 & Giulia Cossu 1 & Michael J. Link 3 & Pierre-Hugues Roche 4 & Ari G. Chacko 5 & Kenji Ohata 6 & Majid Samii 7 & Ashish Suri 8 & Michael Bruneau 9 & Jan F. Cornelius 10 & Luigi Cavallo 11 & Torstein R. Meling 12 & Sebastien Froelich 2 & Marcos Tatagiba 13 & Albert Sufianov 14 & Dimitrios Paraskevopoulos 15 & Idoya Zazpe 16,17 & Moncef Berhouma 18 & Emmanuel Jouanneau 18 & Jeroen B. Verheul 19 & Constantin Tuleasca 1,20 & Mercy George 21 & Marc Levivier 1 & Mahmoud Messerer 1 & Roy Thomas Daniel 1 Received: 15 June 2020 / Accepted: 10 July 2020 # The Author(s) 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 metaanalysis 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. Keywords Large vestibular schwannoma . Combined management . Radiosurgery . Microsurgery . Gross total resection . Subtotal res
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