Facial Nerve Outcomes After Resection of Aggressive Vestibular Schwannomas That Failed Initial Stereotactic Radiosurgery

BACKGROUND AND OBJECTIVES: Surgical management of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS) tumor progression is challenging, particularly regarding facial nerve function and preservation. The aim of this study was to assess whether surgical and facial nerve outcomes are influenced by the VS extent of resection after failed SRS. METHODS: A retrospective review was conducted on 22 patients (11 male) with VS post-SRS progression who underwent surgical resection during the past 3 decades at our center. The primary outcomes measured were facial nerve function using House-Brackmann (HB) scale and tumor recurrence/progression. RESULTS: Patients were divided into gross total (n = 4) resection (GTR) and near-total (n = 10) resection (NTR) or subtotal (n = 8) resection (STR) groups. The patients in the GTR/NTR and STR groups had comparable ages and Koos grades at the time of surgery. Postoperative HB scores showed significantly better facial nerve preservation in the STR group ( P = .02), with no deterioration noted among these patients. By contrast, 7 GTR/NTR patients experienced worsening of facial function; 3 deteriorated to a HB score greater than III. Among these patients with worsening facial function, 1 patient underwent GTR (from HB score I to III), and the other 6 had NTR. The GTR/NTR group had a similar complication rate (n = 7) to the STR group (n = 4, P > .99). Both groups had 100% tumor control at last follow-up with comparable follow-up duration and no tumor recurrence or progression (GTR/NTR, median = 90.8 months [range: 11.8-155.8]; STR, median = 100.6 months [range: 0.5-232]). CONCLUSION: STR of failed SRS VS tumor progression is associated with better facial nerve preservation and similar tumor control rate compared with GTR/NTR, underscoring the importance of conservative surgical strategies in these patients. Based on these limited results, radical resection might not be necessary for tumor control after failed SRS for VS.