Overview of the results of treatment of recurrent vestibular schwannomas – a series of 13 patients

The occurrence of large recurrent or residual vestibular schwannomas (VS) after primary microsurgical treatment or stereoradiotherapy is a relatively rare phenomenon due to the regular follow-up and the frequent use of imaging techniques. The choice of therapeutic approach in patients with residual or recurrent VS remains controversial.

The aim of the study was to retrospectively evaluate our results with the surgical treatment in patients with a residue or recurrence of VS in the period 2004 – 2020. The cohort consisted of 13 patients with large tumors (Koos grade III and IV). The microsurgical tumor removal represented the primary treatment modality in 7 cases, stereoradiotherapy in 4 cases, and a combination of both methods in 2 cases. In only two patients the primary surgical procedure was macroscopically radical.

All revision procedures were performed by retrosigmoid-transmeatal (RS) approach. The revision surgery was radical in 11 cases, in two cases a small residue left did not show any signs of progression during follow-up. In 8 patients the anatomical continuity of the facial nerve (FN) was disrupted during the revision procedure. Primary or secondary reconstruction was successful in 7 cases (HB III-IV). Postoperatively, CSF rhinorrhoea occurred in one case, cerebellar dysfunction in two cases and transient lower cranial nerves lesion in one case. Two patients had postoperative lesion of n.V. function. There were no deaths related to the revision surgery.

Microsurgical resection by the RS approach is challenging, nevertheless it allows radical removal of large residual and recurrent VS with relatively low postoperative morbidity. Preservation of the continuity and function of the FN is challenging particularly in growing tumors after previous stereoradiotherapy.

grant n. 874120 of the 1st Faculty of Medicine, Charles University in Prague

Publication History

Article published online:
24 May 2022