Skull Base 2011; 21(6): 379-384
DOI: 10.1055/s-0031-1287680

© Thieme Medical Publishers

Management of Large and Giant Vestibular Schwannomas

Irumee Pai1 , James Bowman1 , Nick Thomas2 , Neil Kitchen3 , Anthony Strong2 , Rupert Obholzer1 , Michael Gleeson1
  • 1Department of Otolaryngology, Guy's Hospital, London, United Kingdom
  • 2Department of Neurosurgery, King's College Hospital, London, United Kingdom
  • 3Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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14. September 2011 (online)


The study was conducted to analyze outcomes following surgical management of large and giant vestibular schwannomas and management options for residual disease. This retrospective case note study includes patients who had undergone microsurgical resection of sporadic, large, or giant vestibular schwannomas from 1986 to 2008. Tumors are classified as large if the largest extracanalicular diameter was 3.5 cm or greater and giant if 4.5 cm or greater. The study included 45 patients (33 large, 12 giant tumors), mean tumor size 4.1 cm. Total excision was achieved in 14 cases (31.1%), near-total in 26 (57.8%), and subtotal in 5 (11.1%). Facial nerve outcome was House-Brackmann Grade I/II in 25 cases (55.6%), III/IV in 16 (35.6%), and V/VI in 4 (8.9%). No recurrence has been detected in those undergoing a complete resection. No residual tumor growth been observed in 15 of 26 who underwent near-total resection (57.7%). Of 11 patients, 10 received further treatment as their residual tumors showed growth. In the subtotal excision group, one patient died, three have demonstrated no growth, and one residual tumor has grown slightly but not required intervention. Optimal management for patients with large or giant vestibular schwannomas has yet to be determined. Management decisions must balance long term function with tumor control.


Rupert Obholzer M.A. (Oxon) F.R.C.S. (ORL-HNS). 

Department of Ear, Nose, and Throat, Guys Hospital

Great Maze Pond, London SE1 9RT, United Kingdom