The Influence of Primary Surgical Resection on Long-Term Vestibular Schwannoma Recurrence and Progression

Objective: The increasing use of adjuvant radiosurgery and long-term MRI surveillance has prompted many units to adopt a more conservative approach to the primary resection of vestibular schwannomas (VSs) with the aim of reducing neurological morbidity. What is the impact of this policy on the risk of clinically significant tumor recurrence and progression and long-term facial function?

Design: Retrospective analysis of all VS cases treated over a 20-year period by a single skull base surgical team.

Patients/Materials and Methods: Outcome measures were: (1) Extent of resection: total macroscopic (TMR), extrameatal remnant <5 mm, extrameatal plaque >5 mm, intra- and extrameatal remnant, subtotal resection; (2) facial nerve function: HB grade immediately and at 6 months, and (3) patient survival free of tumor re-growth or progression.

Results: In 190 cases with a mean follow-up of 9 years, Kaplan-Meier analysis showed three statistically distinct groups (log-rank, P < 0.0000). Postoperative facial palsy was not significantly different both immediately (P = 0.24) and at follow-up (P = 0.82) between total macroscopic resection (TMR) and all the other groups. However, HB grade III-V rates were higher in the TMR group (P = 0.008).

Conclusions: In our series, resection of intrameatal tumor conferred a recurrence-free survival benefit. The greatest benefit was in the total macroscopic resection group; however, this group was significantly more likely to have poor long-term facial function.