Subtotal Resection of Large Vestibular Schwannoma Is an Effective Treatment

Objective: To assess a single surgeon’s experience in subtotal resection of large vestibular schwannoma (VS), the facial nerve outcome and regrowth rates.

Methods: Retrospective analysis of the management of patients who underwent planned retrosigmoid approach and subtotal resection of VS and has been under regular follow-up during the past 5 years. Information was obtained from medical notes as well as pre- and postoperative radiological investigations.

Results: Twenty-six patients, mean age at the time of surgery 58 years, 10 males and 16 females, mean pre-op size of tumor 36 mm. Preoperatively, four patients had an external ventricular drain (EVD) and seven patients had VP shunt. Mean estimated percentage of resection 94%. Intraoperatively the facial nerve was intact in all cases. Initial post-op House-Brackmann (HB): grade I + II (66%), grade III + IV (23%), grade V + VI (11%). Final HB: grade I + II (81%), grade III + IV (15%), grade V (4%). 6 patients (23%) had growth of residual tumor (3 underwent further surgery with 100% resection of tumor and no recurrence, 2 had stereotactic radiotherapy and no further growth, 1 patient died from other causes at age 92 and did not require further treatment). Mean follow-up 66 months. Complications: 1 meningitis following EVD for post-op hydrocephalus, 1 repair of pseudomeningocele, 1 repair of CSF leak (rhinorrhea).

Conclusion: Subtotal resection with close follow-up may be the treatment option of choice for large VS.