Microsurgery for Recurrent Vestibular Schwannoma after Previous Gross Total Resection

Background: Vestibular schwannoma (VS) recurrence following gross total resection (GTR) is uncommon, occurring in 0.05 to 9.2% of patients. We present a single-institution experience with repeat microsurgery (MS) for recurrent VS following prior GTR and systematic literature review. This is a unique patient population compared with progression after less than GTR resection.

Methods: Retrospective review of a prospectively maintained VS database and supportive systematic review of published series reporting patient-specific outcomes after repeat MS for recurrent VS.

Results: Among 590 patients with prior microsurgical resection of VS, 24 were identified as having undergone repeat MS, six of whom were operated for proven recurrences after primary GTR. At repeat MS, GTR was achieved in four (67%). House-Brackmann (HB) grade I-II facial nerve function was achieved in 5 (87%) patients, including one that improved from preoperative HB grade V function. An alternate surgical approach from the original operation was chosen in four (67%). Systematic review identified four studies documenting 50 patients with individually-reported outcomes after repeat MS for recurrent VS. Our cohort had significantly longer mean time-to-repeat surgery (117 vs. 64 months, p = 0.03), was significantly less likely to have House-Brackmann III-VI function post-revision (17 vs. 68%, p = 0.04), and was significantly less likely to undergo same approach surgery (33 vs. 90%, p = 0.0002); differences in frequency of GTR were non-significant (67 vs. 94%, p = 0.1).

Conclusion: We report a six-patient series of MS for recurrent VS after GTR and the first systematic review of this rare and challenging entity. Anecdotally, our findings suggest that an alternate surgical approach may facilitate easier access to the tumor with less scar encountered during the approach. Our results confirm that repeat MS for recurrent VS is safe and effective, even for larger tumors not typically amenable to stereotactic radiosurgery.

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