Surgical Salvage of Recurrent Vestibular Schwannoma

Background: Disease recurrence following radiotherapy or microsurgical resection of sporadic vestibular schwannoma (VS) is uncommon and understudied. With a growing number of patients receiving primary subtotal resection or low-dose radiosurgery, our ability to manage disease recurrence will become increasingly relevant. The primary objective of the current study is to compare outcomes of salvage surgery for recurrent VS following primary radiotherapy and microsurgical resection. Methods: Retrospective review of all patients that underwent surgical resection of recurrent VS between 2001 and 2013. Results: A total of 32 patients met the inclusion criteria; 16 recurred following microsurgery and 16 after radiotherapy. Those that recurred following microsurgery were younger (median 48.4 vs. 61.6 years; p < 0.001) and had larger tumors (median 1.9 vs. 1.2 cm; p = 0.20) than those presenting with radiotherapy failure. A total of 25 (78%) patients underwent gross-total, 2 (6.3%) near-total, and 5 (15.6%) subtotal resection; the extent of resection was not different between the groups. Patients that received previous radiotherapy experienced a greater decline in facial nerve function (p = 0.01). There were no cases of stroke or mortality. Conclusions: Gross-total resection with facial nerve preservation remains an attainable goal in most patients. These preliminary data suggest that facial nerve outcomes following salvage surgery are more favorable following previous microsurgery compared with previous radiotherapy.