Surgical treatment of giant vestibular schwannomas: facial nerve outcome and tumor control

Abstract Background Surgical treatment of giant vestibular schwannomas (GVS) is challenging. Philosophy of incomplete tumor resection may balance the preservation of facial nerve function and long-term tumor control. Objective We aimed to evaluate the outcome of facial nerve function and tumor control in treating with GVS via our institutional surgical strategy. Methods From September 2009 to August 2014, a total of 218 patients underwent surgical treatment of GVS were enrolled in our study. The clinical features, extent of resections, facial nerve outcome and the tumor regrowth free rate of these patients were retrospectively analyzed. The treatment strategy of this disease was discussed. Results All the patients had anatomical preservation of the facial nerve. Gross total resection (GTR) was achieved in 58 patients (28.6%) and near-total resection (NTR) in 103 (50.7%), subtotal resection (STR) in 42 (20.7%). Two patients died due to postoperative complications. After a mean follow-up of 39.7±18.3 months, the favorable facial nerve outcome was achieved in 58.6% in GTR patients and 79.6% in NTR, 83.3% in STR, respectively. During follow-up period, twenty patients suffered from tumor regrowth and were treated by stereotactic radiosurgery (SRS), and tumor regrowth free rate were 96.6% in GTR and 92.2% in NTR, 76.2% in STR, respectively. The extent of resection was the independent risk factor for poor facial nerve function (P=0.006). Conclusion Surgical philosophy of prioritizing facial nerve preservation over total tumor resection was recommended in treatment of GVS. Favorable facial nerve outcome and tumor control could be achieved after NTR of the tumors.