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Subtotal/near-total treatment of vestibular schwannomas

Gurgel, Richard K.a; Theodosopoulos, Philip V.b; Jackler, Robert K.c

Current Opinion in Otolaryngology & Head & Neck Surgery: October 2012 - Volume 20 - Issue 5 - p 380–384
doi: 10.1097/MOO.0b013e328357b220
OTOLOGY AND NEURO-OTOLOGY: Edited by Ravi N. Samy

Purpose of review: The review evaluates current literature on subtotal and near-total resection of vestibular schwannomas.

Recent findings: Recent findings suggest that subtotal and near-total resection of vestibular schwannomas can be performed to improve facial nerve outcomes. This is particularly true for large tumors. Whereas postoperative facial nerve function is likely improved by partial resection, recurrence rates are higher, although they vary depending on the extent of resection. If a tumor remnant grows following partial resection, the small-volume remnant can be treated with stereotactic radiation with good tumor control rates.

Summary: Subtotal and near-total resection of vestibular schwannomas is a reasonable surgical paradigm for vestibular schwannomas which cannot be completely removed without injuring the facial nerve. Whereas facial nerve outcomes are more favorable in partial resections, the risk of recurrence increases and is proportional to the volume of residual tumor.

aDivision of Otolaryngology – Head and Neck Surgery, University of Utah, Utah

bDepartment of Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio

cDepartment of Otolaryngology – Head and Neck Surgery, Stanford University, Stanford, California, USA

Correspondence to Richard K. Gurgel, MD, Division of Otolaryngology – Head and Neck Surgery, University of Utah Hospitals and Clinics, 50 N Medical Dr Salt Lake City, UT 84132, USA. Tel: +1 801 587 8368; fax: +1 650 725 6685; e-mail: richard.gurgel@hsc.utah.edu

© 2012 Lippincott Williams & Wilkins, Inc.