Microsurgery for Large Vestibular Schwannomas: A Series of 45 Patients

Objective: Vestibular schwannomas (VS) presented for surgery in an era of radiosurgery are mainly large tumors (>2.5 cm). We present a retrospective study to assess our surgical results. Study Design: We reviewed the data of 45 patients with large VS operated in our center from 2008 to 2013. We evaluated tumor volume, cranial nerve status, surgical approach, extent of resection, complications, tumor recurrence, and postoperative complaints. We compared the results with the larger series described in the literature. Results: Mean age was 46 years. Mean follow-up was 21 months. Tumor size was on average 31.2 mm. Retrosigmoidal (40%), translabyrinthine (55%), and presigmoidal retrolabyrinthine (5%) approach was used. Gross-total resection was obtained in 38 patients (85%), near-total in 6 (13%), and a subtotal in 1 patient (2%), respectively. Tumor control rate at last follow-up was 100% without additional treatment. Hearing preservation surgery was only successful in four patients. Early deterioration of facial nerve function was seen in 42% but improved to normal function in 78%. Late follow-up documented frequent complains of headache (29%) and vestibular dysfunction (52%). Conclusion: We present a series of surgically treated large VS. Our results are comparable to larger studies. Concerning facial nerve preservation the question rises whether subtotal removal and adjuvant treatment is an option with equal tumor control in the long run.