Introduction: Surgery for vestibular schwannomas after radiation therapy failure is associated
with increased technical difficulty, incomplete resection, and deterioration in facial
nerve function. (Limb 2005, Iwai 2007, Lee 2010, Husseini 2013, Hong 2013, Lee 2014)
We report our experience with surgery for vestibular schwannomas after radiation with
regards to extent of resection and preservation of facial nerve function.
Methods: This retrospective study was approved by the institutional review board. Patients
who underwent surgery for vestibular schwannoma after failing initial radiation therapy,
were included in the study. Exclusion criteria included prior surgery. Patient demographics,
surgical approach, tumor size, intraoperative findings, extent of resection, and pre-
and post-operative House-Brackmann (HB) scores were reviewed. Extent of resection
was classified as gross total resection (GTR, no residual tumor), near total resection
(NTR, less than 5mm of tumor along the brainstem or nerve), or subtotal resection
(STR, greater than 5mm residual tumor).
Results: Between 2004 and 2015, ten patients underwent surgery after failing initial radiation
therapy. One patient who had undergone prior surgical resection was excluded. Indications
for surgery included tumor progression on magnetic resonance imaging with or without
symptoms of mass effect and cranial nerve dysfunction. The mean maximal tumor diameter
prior to surgery was 2.1 cm. The mean interval between radiation therapy and surgery
was 3 years (range 2–6 years). All patients had a preoperative HB score of 1. Six
cases involved a translabyrinthine approach, resulting in five GTR’s and one STR.
NTR was achieved in two cases through a retrosigmoid approach. At a mean follow-up
of 5 months (range 1–85 months), eight patients were HB 1 and two patients were HB
4 (both underwent GTR).
Conclusions: Despite increased technical difficulty, extensive resection of vestibular schwannomas
can be achieved after radiation therapy with reasonably good preservation of facial
nerve function.
Table 1 Patient demographic and clinical information
