Vestibular Schwannomas: Challenges of Surgical Salvage after Failed Stereoradiosurgery

Stereoradiosurgery (SRS) proved to be an effective alternative to microsurgery in patients with vestibular schwannomas (VS) in cases of primary microsurgery failure. Is this true?

Results and complications were compared in two groups of patients treated during 1997 to 2007: primary radical removal (n = 210), and radical removal following partial surgery and/or gamma knife SRS failure (n = 11).

Ninety percent were large (grade III and IV) tumors. All patients underwent removal by the same team and the retromastoidal approach with intraoperative nerve monitoring. In cases of primary treatment we achieved anatomical preservation of nerve VII in 97% with House-Brackmann I to III function in 87%. We spared useful hearing in 73% of preoperatively useful hearing ears. Most of the patients returned to previous social activities. In cases of surgery after partial resection and SRS failure, satisfactory function of nerve VII was achieved in 9% only with no hearing. Further neurological deficits were common and led to invalidity. It was difficult to achieve complete removal. Proliferating cells were confirmed histologically in all tumors after SRS.

Growing VS should be treated by primary radical microsurgery. SRS did not prove to be an effective alternative to microsurgery in patients in whom the initial microsurgical removal failed.-