Surgical Treatment of the Giant Vestibular Schwannomas (KOOS IV): Single Surgeon’s Experience—Case Series of 30 Patents

Introduction: Surgery for vestibular schwannomas (VS) of large and giant sizes is a complex problem, the goal of which is the most radical removal of the tumor and preservation of the function of the facial nerve.

Materials and Methods: This study conducts a retrospective analysis of the results of treatment of patients with VS measuring more than 30 mm (on the KOOS scale of 4 degrees) in the neurosurgical department for a period of 3 years (2020–2023) performed by the first author. In all operations, a retrosigmoid approach and intraoperative neurophysiological monitoring were used.

Results: A total of 30 patients (21 women and 9 men) were operated, among whom 3 (10%) had undergone previous surgeries and had facial nerve palsy, 1 (3%) patient had received radiosurgery prior to the operation. The average age of the patients was 46.1 ± 15.6 years. 5 (16%) patients had reduced hearing, while 25 (84%) patients had complete hearing loss on the tumor side. 19 (64%) patients had trigeminal nerve neuropathy before surgery. Total resection was achieved in 5 (16%) patients, while subtotal resection was performed in 25 (84%) patients. Intraoperative drilling of the internal auditory canal was performed in 23 (77%) patients. The rate of “good” postoperative outcomes regarding facial nerve function (House-Brackmann [HB] grades I and II) was 54% (16 patients), while “poor” outcomes (HB grades III-VI) occurred in 46% (14 patients). All patients with total tumor resection experienced worse outcomes (HB III-VI). After one year of follow-up, 6 (20%) patients showed improvement in facial nerve function: the HB grade I–II group comprised 18 (60%) patients. 2 (6%) patients underwent decompression of the posterior cranial fossa within the first 24 hours after the removal of the schwannoma due to developing edema of the cerebellar hemisphere. There were no infectious complications, cerebrospinal fluid leaks, and mortality cases in this series.

Conclusion: Treatment of vestibular schwannomas is a complex problem, especially when the tumor size is large and gigantic. The use of modern neurosurgical technology and neurophysiological monitoring allows us to achieve good results.

Publication History

Article published online:
07 February 2025