Introduction: Aim of this work is to asses whether there is a difference in results between primary total removal of vestibular schwannoma (VS) and totally removed tumors after previous subtotal/partial resection and unsuccessful steroradiosurgery (SRS). Some authors believe that SRS is effective alternative to microsurgery in patients with VS in case of primary microsurgery failure. Is this really true?

Methods: Results and complications were compared in 2 groups of patients treated during 1997-2013: primary radical removal (n = 333), and radical removal following partial surgery and/or gamma knife SRS failure (n = 11).

Results: 90% of treated VS were large Grade III and IV tumors. All patients underwent removal by same team and retrosigmoid-transmeatal approach with intraoperative neuromonitoring. In the group of primary microsurgery 329/333 (99%) were removed radically. We observed 2 cases of tumor recurrence however any of these patients needed any other treatment. In case of primary microsurgery we achieved anatomical preservation of CN VII in 311/333 (96%) with House-Brackmann I-III function in 87%. We spared useful hearing in 41/333 (12%) of patients. Vast majority of these patients returned to previous social and working activities. In case of surgery after partial resection and SRS failure it was extremely difficult to achieve radical removal. Satisfactory function of CN VII was achieved in 1/11 (9%) only without chance of hearing preservation. Further neurological deficits were common and leaded to invalidity of such patients. Viable and proliferating tumor cells were proven histologically in all tumors after SRS.

Conclusions: This analysis and video support the opinion that growing VS should be treated by primary radical microsurgery. SRS did not prove to be effective alternative to microsurgery in patients in whom the initial microsurgical removal failed.

Patient Care: Improved results of following vestibular schwannoma surgery

Learning Objectives: At the end of the session follower should be able to choose the optimal method for radical treatment of growing VS

References: Samii M, Gerganov V. Surgery of Cerebellopontine Lesions: Springer; 2013. pp 885