Assessing the Implication of Plasma Matrix Metalloproteinase-9 on Extent of Resection During Vestibular Schwannoma Surgery

Tuesday, October 1, 2024

11:00 AM – 11:06 AM EDT

Location: MBCC, 231

Disclosure(s):

Robert J. Macielak, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Han TN Nguyen, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Lisa Zhang, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Oliver F. Adunka, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Subtotal resection of vestibular schwannoma (VS) carries significant morbidity and long-term management implications. Contributing factors include large tumor size, cystic change, and increased tumor adherence to the brainstem. Identifying plasma markers that predict tumor adhesiveness, and thus the extent of tumor resection (EOR), may guide clinical decision-making and reduce postoperative morbidity.

Methods: Plasma and tumor samples were prospectively collected from patients with non-radiated, sporadic VS who underwent either gross total resection (GTR) or subtotal resection (STR) at a tertiary skull base referral center from July 2022 to June 2023. The level of matrix metalloproteinase-9 (MMP-9) in plasma was measured by ELISA. The predictive ability on intraoperative assessment of tumor adherence to brainstem and postoperative outcomes were assessed.

Results: Eighteen patients were included (6 females, median age 53, median tumor size 26.7 mm). GTR was performed in 11 patients (61%) and STR in 7 (39%). Tumor size was larger in the STR than GTR group (33.2 vs. 21.2 mm, p=0.002). Intraoperatively, a higher fraction of STR tumors were adherent (85.7% vs. 36.3%, p=0.04). Plasma MMP-9 levels were higher in the STR cohort (184.2 vs. 103.8 pg/mL, p=0.004). On logistic regression, tumor size was a significant predictor of adherence (p=0.02) but not EOR (p=0.15). Plasma MMP-9 strongly predicted EOR (p=0.03). A combination of plasma MMP-9 and tumor volume was strongly predictive of both tumor adherence (area under the curve [AUC]=0.83, p=0.03) and EOR (AUC=0.79, p=0.02) and outperformed other clinical variables.

Conclusions: When combined with tumor volume, plasma level of MMP-9 was strongly predictive of VS adherence assessed intraoperatively and EOR postoperatively. These data may provide critical preoperative information regarding surgical difficulty, postoperative morbidities, and the likelihood of achieving gross total tumor removal. Ultimately, such measurements could prove invaluable in both patient and provider decision-making.

Presenting Author(s)

Robert J. Macielak, MD

Fellow
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Han TN Nguyen, PhD

Post-doctoral Fellow
The Ohio State University Wexner Medical Center
Columbus, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
LZ

Lisa Zhang, MD

Resident
The Ohio State University, Department of Otolaryngology-Head and Neck Surgery
Columbus, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
OB

Olivia M Brickey, BS

Graduate Research Assistant
The Ohio State University Wexner Medical Center, United States

Disclosure information not submitted.
DS

Desi P. Schoo, MD

Assistant Professor
Ohio State University
Columbus, OH, United States

Disclosure information not submitted.
OA

Oliver F. Adunka, MD, MBA

Professor
Ohio State University
Columbus, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

YR

Yin Ren, MD, PhD

Assistant Professor
Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.