Abstract
Background The novel paradigm in neurosurgery for large vestibular schwannomas (VSs) involves
a combination of planned subtotal resection (STR) and scheduled postoperative fractionated
stereotactic radiotherapy (FSRT).
Methods This retrospective observational study aimed to evaluate and compare the outcomes
of patients who underwent either near-total resection (NTR) or were treated with STR
and scheduled FSRT over 6 years. We systematically coded and analyzed the data to
obtain comprehensive insights into the results.
Results Our study included 65 patients diagnosed with large VS, who underwent retrosigmoid
craniotomy and NTR or STR for tumor removal. The mean age of the cohort was 42.6 (standard
deviation: 16.2) years, with 40 (61.5%) female patients. All patients presented with
asymmetrical sensory neural hearing loss and other prevalent symptoms such as headache
(58) and tinnitus (58). Cerebellar signs, speech abnormalities, and pyramidal signs
were also observed. Ten patients underwent NTR, and 55 underwent STR followed by an
FSRT at 3 months or later based on the physical and radiological findings. Facial
nerve palsy was noted in all cases of those who underwent NTR, while no instances
of facial nerve palsy, lower cranial nerve palsy, posterior fossa, or brain stem injury
were noted in the STR group. One patient undergoing STR experienced meningitis and
died despite best possible medical management. The majority of patients showed symptom
improvement, and none of the patients reported recurrence at 3-year follow-up.
Conclusion The combined approach of STR and FSRT ensures safety, high tumor control rates, and
favorable outcomes. It provides a sensible alternative to NTR for managing large tumors,
emphasizing tumor debulking while preserving neurological function for overall benefit.
Keywords vestibular schwannoma - cerebellopontine angle - adjuvant stereotactic radiotherapy
- subtotal resection - near-total resection - adaptive hybrid surgery
