Objective: To correlate tumor volume relationship with accepted nomenclature alongside surgical
outcomes in subtotal resections. Study Design: Retrospective study. Setting: Charing Cross Hospital, London, a tertiary referral
center. Participants: Total 16 patients with vestibular schwannoma managed with subtotal
resection between 2002 and 2011. Main Outcome Measures: Surgical technique; tumor
volume; recurrence; postoperative facial nerve function. Results: Mean preoperative and postoperative volumes for all patients were 14.7 and 3.7 cm
respectively. Tumor volumes do not correlate with diameter (p?0.05). Mean reduction in volume of these subtotal resections was 75%. Long-term facial
nerve outcome was good in the majority of patients: House-Brackmann grade I/II in
12 (75%), grade III/IV in 2 (12.5%), and Grade V/VI in 2 patients (12.5%). Notably,
two patients with grade I/II House-Brackmann grading later developed grade V/VI palsy
following adjunctive radiotherapy. Seven of the 16 subtotal resections had subsequent
radiotherapy or microsurgery. Mean follow-up was 26.5 months. Conclusion: Subtotal resections lead to good facial nerve outcomes but may require further treatments.
Radiation treatment can worsen facial nerve function. There is no standardized use
of tumor volumes or accepted guidelines for resection terminology. We propose the
use of tumor volumes to define this further.
