2026 Proffered Presentations
S078: NEUTROPHIL-TO-LYMPHOCYTE RATIO AND FLAIR IMAGING BIOMARKERS IN VESTIBULAR SCHWANNOMA: A SINGLE-CENTER RETROSPECTIVE STUDY
Emma C Dunn, BS1; Bryan Clampitt, BS1; Jacob Parker, BS1; Mohammed Hassan Nour El Dine, MD, MSc2; Emily Coughlin, MPH, CPH1; Rahul Mhaskar, PhD3; Siviero Agazzi, MD, MBA2; Davide Croci, MD2; 1University of South Florida Morsani College of Medicine; 2Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA; 3Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
Background and Purpose: Vestibular schwannomas (VS) frequently cause cranial neuropathies, and reliable predictors of postoperative outcomes remain limited. Systemic inflammatory markers, particularly neutrophil-to-lymphocyte ratio (NLR), and imaging biomarkers such as fluid-attenuated inversion recovery (FLAIR) signal changes have independently been associated with tumor behavior and outcomes. However, the relationship between systemic inflammation and longitudinal FLAIR changes remains undefined. The aim of this study is to investigate the influence of NLR on FLAIR imaging indices and long-term cranial nerve outcomes in patients undergoing microsurgical resection of VS.
Methods: We retrospectively reviewed patients undergoing translabyrinthine resection of VS between 2013-2022. Pre- and postoperative NLR were analyzed for correlation with imaging indices. MRI was performed at intervals (preoperative, 48 hours, 2–12 months, and long-term follow-up) to quantify FLAIR signal intensity and cerebellopontine angle thickness indices. Associations between NLR, tumor size, imaging indices, and CN VII deficit were assessed using Spearman correlations and repeated measures analysis, with tumor size and age entered as covariates.
Results: Fifty-six patients met inclusion criteria; preoperative NLR was available for 66%. Preoperative NLR correlated with long-term imaging, positively with FLAIR (rho = 0.450, p = 0.031) and negatively with thickness (rho = –0.477, p = 0.021). Tumor size correlated with early imaging (preop FLAIR rho = 0.401, p = 0.004; 48-hr FLAIR rho = 0.660, p < 0.001) and inversely with early thickness (preop rho = –0.762, p < 0.001; 48-hr rho = –0.440, p = 0.004), but not later measures. FLAIR indices were stable over time (p = 0.287), while thickness peaked at 2–12 months then declined, though the effect was explained by tumor size. Clinically, longer length of stay correlated with higher 48-hour FLAIR (rho = 0.330, p = 0.033). Preoperative CN VII deficit was associated with larger tumor size (p = 0.036), and long-term CN VII deficit correlated with higher long-term FLAIR (p = 0.025) and longer hospitalization (p = 0.003).
Conclusions: Preoperative NLR correlated with long-term FLAIR and thickness indices, suggesting systemic inflammation may affect delayed tissue remodeling. Tumor size strongly predicts early imaging changes and is associated with pre-op CN VII status. Integrating systemic and imaging biomarkers may enhance prognostication in VS surgery.