Introduction
Patients and methods
Literature review
Reference (1st author country, year) | Number of patients | Age (years) | Gender | Tumor size | Approach | Extent of resection | Preserved anatomical facial nerve integrity | Functional outcome (HB grading) |
---|---|---|---|---|---|---|---|---|
Chang S Canada 2019 [8] | 434 | 49.1 (13–81) (mean (range)) | m 213 f 221 | 26 ± 1 mm (mean ± SD) | RSA 85% TLA 7.3% MFA 3.9% | GTR 83.0% NTR 9.0% STR 8.1% | n.a. | G 1–2 96% G 3–6 4% |
Huang X China 2018 [22] | 103 | 47.5 (22–71) (mean (range)) | m 48 f 55 | 32 mm (mean) | n.a. | n.a. | Only intact included | G 1–2 76% G3–6 24% |
Hong WMa China 2017 [18] | 105 (IOM used in 83.1%) | 48.7 (14–73) (mean (range)) | m 41 f 64 | 90.5% ≥ 30 mm | RSA | GTR 80.9% STR 14.3% PR 4.8% | 95.3% | G 1–2 74.4% |
Boublata L Algeria 2017 [7] | 151 | 48.2 (17–78) (mean (range)) | m 43 f 98 | 31–60 mm | RSA | GTR/NTR 82.6% STR 13.9% PR 3.3% | 98.7% | G 1–2 82% G 3–4 12% G 5–6 6% |
Huang X China 2017 [21] | 657 (IOM used in 81.2%) | 46.8 (12–80) (mean (range)) | m 368 f 289 | > 40 mm | RSA | GTR 84.6% NTR 15.1% PR 0.3% | 89.6% | G 1–2 55.8% G 3 19.8% G 4–6 24.4% |
Huang X China 2017 [20] | 1167 (IOM used in 82%) | 47.5 (12–80) (mean (range)) | m 535 f 632 | > 30 mm | RSA | GTR 86.2% STR 13.6% PR 0.2% | 92.8% | G 1–2 87.9% G 3–4 11.6% G 5–6 0.3% |
Torres R France 2017 [53] | 229 | 49 (15–84) (mean (range)) | m 92 f 137 | 61% < 15 mm 7% > 30 mm | TLA 78% RSA 21% MFA 1% | n.a. | n.a. | G 1–2 84% G 3–4 15% G 5–6 1% |
Bhimrao S Canada 2016 [6] | 367 | 49 (13–81) (mean (range)) | m 178 f 189 | 26 ± 10 mm (mean ± SD) | RSA 87% TLA 10% MFA 3% | STR 9% | n.a. | G 1–2 95.2% G 3–4 4.2% G 5–6 0.6% |
Kunert P Poland 2016 [25] | 212 | ≤ 50, n = 121 > 50, n = 91 | m 83 f 129 | 30 mm (mean) 56% ≤ 30 mm 44% > 30 mm | RSA 99% TLA 1% | GTR 99% NTR 1% | 84–94% | G 1–3 77% G 4–6 23% |
Nejo Tb Japan 2016 [35] | 556 D: 21 ND 535 | 46 (11–78) (median (range)) | m 246 f 310 | D: 28 mm (10–45) ND: 24 mm (0–64) (mean (range)) | RSA | GTR or NTR D: 38.1% ND: 85.4% | D:100% ND: 99.4% | G1–2 D: 95.2% ND: 97% |
Zhang J China 2015 [58] | 221 | 46.1 (29–73) (mean (range)) | m 105 f 116 | 82.8% ≥ 30 mm 17.2% < 30 mm | RSA | NTR 90% STR 10% | n.a. | G1–3 82.8% G4 7.2% G5 10% |
Liu SWc China 2015 [26] | 106 | 48 (19–76) (mean (range)) | m 40 f 66 | ≥ 30 mm | RSA | GTR 82.1% STR 14.2% PR 3.7% | 98.1% | G1–2 79.3% G3 20.8% G4 0.9% |
Spektor S Israel 2015 [46] | 130 | 44.3 (14–83) (mean ((range)) | m 54 f 76 | 30 ± 11 (10–60) (mean ± SD (range)) | n.a. | GTR 76.1% STR 20.0% PR 3.9% | n.a. | G1–2 83.1% G3–4 13.1% G5–6 4.7% |
Porter R USA 2013 [38] | 153 (63 single surgery, 75 staged surgery) | 55.8 (13–83) in single 46.4 (17–80) in staged (mean (range)) | m 82 f 71 | ≥ 30 mm | TLA in single, followed by RSA in staged | In single surgery: GTR 46% NTR 30% STR 24% | n.a. | G1–2 75% in single 81% in staged |
Schmitt W 2013 USA [44] | 267 | 48 (15–86) (mean (range)) | m 120 f 147 | 24 mm (8–60 mm) (mean (range)) | RSA 58.5% TLA 34% MFA 7.5% | GTR 75% NTR 12% STR 13% | Only intact included | G1–2 84% |
Marin P 2011 Canada [28] | 106 | 50.4 (20–78) (mean (range)) | m 63 f 43 | 17.5 mm (average) | TLA 61% RSA 38% both 1% | n.a. | Only intact included | G1–2 95% |
Amano M 2011 Japan [2] | 216 | 45.1 (14–76) (mean (range)) | m 104 f 112 | 25 mm (0–55 mm) (mean (range)) | RSA | resection rate 98.2% (85–100%) (mean (range)) | 100% | G1–2 98.6% |
Morton Rd 2011 USA [33] | 104 | 39.6 (13–71) (mean (range)) | m 53 f 51 | DFP 20.8 ± 8.6 mm IFP 32.2 ± 16.0 mm no FP 21.2 ± 16.0 mm (Mean ± SD) | RSA 47.1% TLA 41.3% MFA 2.9% RSA+TLA 8.7% | n.a. | n.a. | G1–2 97.1% |
Sughrue M 2010 USA [49] | 477 | 49–51 (range of means) | m 223 f 245 | 20–30 mm (range of means) | TLA 50% MFA 22.8% RSA 22.8% | GTR 69.2% NTR 14.0% STR 16.8% | n.a. | G1–2 57.4% G3–6 42.6% |
Chen L 2010 China [10] | 145 | 42.3 (22–71) (mean (range)) | m 77 f 68 | 82% > 30 mm 18% ≤ 30 mm | RSA | GTR 96.6% | 91% | G1–2 79.3% |
Bernat 2010 France [5] | 120 | 50 (23–83) (mean (range)) | m 53 f 67 | 60% ≤ 15 mm 12.5% > 30 mm | TLA 78% MFA 3% RSA 13% Transotic 6% | n.a. | n.a. | G1–2 69% G 3–4 18% G 5–6 13% |
Chen L 2009 China [9] | 103 | 45.1 (19–76) (mean (range)) | m 45 f 58 | 38 mm (15 – 67 mm) (mean (range)) | RSA | GTR 98.1% STR 1.9% | 98.1% | G1–2 83.5% G3–4 17.5% |
Shamji M 2007 Canada [45] | 128 | n.a. | n.a. | 23 mm (5–70 mm) (average (range)) | TLA | n.a. | n.a. | G1–2 87% |
Samii Me 2006 Germany [42] | 200 | 46.8 (18–73) (mean (range)) | n.a. | T1 11%, T2 9%, T3a 14%,T3b 20%, T4a 36%, T4b 10% | RSA | GTR 98% STR 2% | 98.5% | G1–2 81% |
Meyer T 2006 USA [32] | 162 | 49 (19–70) (mean (range)) | m 83 f 79 | 2–25 mm (range) | MFA | GTR 100% | 100% | G1 86.4% G2 10.5% G3 3.1% |
Zhang X 2005 China [59] | 105 | 46.8 (21–75) (mean (range)) | m 41 f 64 | > 40 mm | RSA | GTR 86.7% STR 13.3% | 79.1% | G1–2 56.7% G3–4 21.8% G5–6 21.9% |
Isaacson B 2003 USA [23] | 229 | 51 (15–79) (mean (range)) | m 114 f 115 | 19 mm (4 – 65 mm) mean (range) | TLA 59% RSA 29% MFA 12% | n.a. | 97% | G1–2 87% |
Magnan J 2002 France [27] | 119 | n.a. | n.a. | < 25 mm | RSA | n.a. | 100% | G1–2 96% |
Tonn J-C 2000 Germany [52] | 508 (IOM 396, 80%) | 51.3 (14–80) (mean (range)) | m 263 f 245 | 8–40 mm (range) | RSA | n.a. | n.a. | G1–2 With IOM 88.7% Without IOM 69.5% |
Patients
Treatment protocol
Follow-up
Statistical methods
Ethical aspects
Results
Good outcome (HB 1–2) n = 59 (67%) | Moderate outcome (HB 3–4) n = 14 (16%) | Poor outcome (HB 5–6) n = 15 (17%) | Difference between groups | |
---|---|---|---|---|
Age (mean ± SD) | 51 ± 13 years | 55 ± 16 years | 55 ± 15 years | |
Gender (male/female) | 20/39 | 7/7 | 6/9 | |
Size1 | p < 0.05 | |||
Intrameatal | 2 (4.1%) | 1 (7.1%) | 1 (7.7%) | |
Small | 6 (12.2%) | 1 (7.1%) | – | |
Medium | 31 (63.3%) | 4 (28.6%) | 5 (38.5%) | |
Large | 10 (20.4%) | 8 (57.1%) | 7 (53.8%) | |
Largest diameter2 (mean ± SD, range) | 24 ± 12 mm 0–53 mm | 33 ± 10 mm 0–51 mm | 32 ± 15 mm 0–50 mm | p < 0.05 |
Volume2 (mean ± SD, range) | 9000 ± 11,000 mm3 26–49,000 mm3 | 16,000 ± 11,000 mm3 3200–34,000 mm3 | 17,000 ± 21,000 mm3 2700–47,000 mm3 | p < 0.05 |
Koos grade (mean ± SD, range) | 3.4 ± 0.9 1–4 | 3.6 ± 0.6 2–4 | 3.8 ± 0.4 3–4 | |
Clinical presentation | ||||
Hydrocephalus | 7 (11.9%) | 4 (28.6%) | 5 (33.3%) | |
Headache | 9 (15.3%) | 4 (28.6%) | 5 (33.3%) | |
Vertigo | 35 (59.3%) | 6 (42.9%) | 6 (40.0%) | |
Imbalance/ataxia | 12 (20.3%) | 5 (35.7%) | 9 (60.0%) | p < 0.01 |
Hearing | 51 (86.4%) | 11 (78.6%) | 14 (93.3%) | |
Tinnitus | 19 (32.2%) | 3 (21.4%) | 6 (40.0%) | |
Facial | 1 (1.7%) | 2 (14.3%) | 3 (20.0%) | p < 0.05 |
Trigeminal | 15 (25.4%) | 3 (21.4%) | 2 (13.3%) | |
Brainstem/cerebellar | 5 (8.5%) | 1 (7.1%) | 5 (33.3%) | p < 0.05 |
Hearing class3 (mean, range) | ||||
Preoperative | 2.4 (1–5) | 2.6 (1–3) | 3.3 (2–5) | |
Postoperative | 4.1 (1–5) | 4.2 (1–5) | 5.0 (5) | |
Change | 1.8 | 1.6 | 2.3 | |
Extent of resection | ||||
Gross total | 17 (29.3%) | 4 (28.6%) | 5 (33.3%) | |
Near total | 35 (60.3%) | 10 (71.4%) | 7 (46.7%) | |
Subtotal | 6 (10.3%) | – | 2 (13.3%) | |
Partial | – | – | 1 (6.7%) | |
Drilling4 | 28 (48.3%) | 7 (50.0%) | 7 (46.7%) | |
Threshold increase5 | 2 (2.3%) | 2 (16.7%) | 4 (66.7%) | p < 0.001 |
Loss of response5 | – | 2 (15.4%) | 3 (37.5%) | p < 0.01 |
Complication6 | 4 (6.8%) | 2 (14.3%) | 4 (26.7%) | |
Regrowth7 | 12 (20.3%) | 3 (23.1%) | 6 (40.0%) |
Before CK (n = 73) 2001–2012 | After CK (n = 22) 2013–2017 | ||
---|---|---|---|
Age (mean ± sd) | 53 ± 14 years | 52 ± 16 years | |
Gender (male/female) | 30/43 | 7/15 | |
Diameter (mean ± sd) | 25 ± 14 mm | 31 ± 9 mm | p < 0.05 |
Volume (mean ± sd) | 10,400 ± 12,100 mm3 | 14,100 ± 11,400 mm3 | p < 0.05 |
Size1 | |||
Intrameatal | 6.6% (n = 4) | – | |
Small | 11.5% (n = 7) | – | |
Medium | 50.8% (n = 31) | 54.5% (n = 12) | |
Large | 31.1% (n = 19) | 45.5% (n = 10) | |
Koos grade (mean ± sd (range))2 | 3.32 ± 0.81 (1–4) | 3.95 ± 0.21 (3–4) | |
Extent of resection | p < 0.01 | ||
Gross total | 36.1% (n = 26) | 9.1% (n = 2) | |
Near total | 47.2% (n = 34) | 90.9% (n = 20) | |
Subtotal | 13.9% (n = 10) | – | |
Partial | 2.8% (n = 2) | – | |
Drilling3 | 58.3% (n = 42) | 9.1% (n = 2) | p < 0.001 |
Complication4 | 15.1% (n = 11) | 4.5% (n = 1) | |
Regrowth5 | 24.7% (n = 18) | 19.8% (n = 4) | |
Facial nerve outcome6 | p < 0.05 | ||
Good | 65.2% (n = 43) | 68.4% (n = 13) | |
Moderate | 12.1% (n = 8) | 31.6% (n = 6) | |
Poor | 22.8% (n = 15) | – | |
Hearing class (mean ± SD) 7 | |||
Preoperative | 2.5 ± 1.2 | 2.6 ± 1.5 | |
Postoperative | 4.2 ± 1.3 | 4.3 ± 0.9 | |
Change | 1.7 ± 1.4 | 2.0 ± 1.5 |