Continued Growth and Recidivation of Vestibular Schwannomas

The problems of recidivating and continued growing of vestibular schwannomas are considered on material from 336 observations of patients. There were 25 (7.4%) tumors of clinical stage III and 311 (92.6%) of stage IV. Total removal of tumor was made in 262 (78.0%) cases, subtotal removal in 42 (12.5%) cases, and partial removal in 32 (9.5%) cases. Facial nerve was preserved in 245 (72.9%) cases. Postoperative mortality amounted to 2.7% (9) cases. Thirty (8.9%) patients were reoperated. Eighteen (6.9%) patients had recidivation after total removal of neurinomas, 5 (11.9%) patients after subtotal removal. Average time of the observation was 49.9 months and 24.6 months, respectively. Continuing growth of tumors after their partial removal was noted in 7 (21.9%) cases. Malignancy of schwannomas was the reason for recidivating in two cases. The residual part of the tumors' capsule, usually left on the brainstem or facial nerve at subtotal removal of tumors, was a reason for recidivation only in 1 (3.6%) case. Total removal of recidivating tumor was made in 12 (40.0%) cases, subtotal in 7 (23.3%) cases, and partial in 11 (36.7%) cases. We noted that in all cases of recidivating or continued growth of vestibular schwannomas, patients endured the repeated surgical procedure very well. We conclude that one of the ways to reduce postoperative mortality must be an expansion of the evidence to partial removal of tumor in cases accompanying with somatic pathology and to subtotal removal in cases with difficult tumor capsule microdissection from the brainstem and facial nerve.