Skull Base 2007; 17(2): 109-117
DOI: 10.1055/s-2006-953510

Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Large and Giant Residual and Recurrent Vestibular Schwannomas

Ricardo Ramina1 , Maurício Coelho Neto1 , Kelly Cristina Bordignon1 , Tobias Mattei2 , Rogério Clemente1 , Paulo Henrique Pires Aguiar2
  • 1Neurosurgical Department, Neurological Institute of Curitiba, Curitiba, Brazil
  • 2Neurosurgical Department, University of São Paulo, São Paulo, Brazil
Further Information

Publication History

Publication Date:
01 November 2006 (online)


This report is a retrospective analysis of the surgical outcome of 15 patients (8 females, 7 males; mean age, 37.8 years) with residual or recurrent vestibular schwannomas operated on between 1987 and 2005. These 15 patients were part of a larger series of 252 consecutive vestibular schwannoma excisions. Tumors were classified as large (10) when their diameter exceeded 3.5 cm and giant (5) when their diameter exceeded 4.5 cm. All patients had previously undergone surgery. Hearing was lost in all cases, 8 had complete facial nerve palsy, 6 had trigeminal nerve deficits, 5 had cranial nerve IX and X palsy, and 10 had ataxic gait. Twelve patients had hydrocephalus. The tumors were reoperated through the retrosigmoid-transmeatal approach. The mean postoperative follow-up was 4.9 years. Complete resection was achieved in all patients. The facial nerve was preserved in 6 of the 7 patients with preoperative facial function. Transient worsening of bulbar cranial nerves palsy occurred in 2 cases. Cerebrospinal fluid leakage occurred in 3 patients. There were no deaths, and the tumors were histologically benign. Surgical removal is the only treatment for these lesions. Total resection associated with a low morbidity rate is possible. Preservation of the facial nerve is difficult due to severe scar tissue.


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Ricardo RaminaM.D. 

R. Gonçalves Dias 713

80240-340 Curitiba, Brazil