Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study-Part II- Tumor Regrowth

Ashkan Monfared; Richard K Gurgel; Philip V Theodosopoulos; Thomas L Haupt; Ronald E Warnick; Parisa Sabetrasekh; Carleton Eduardo Corrales; Yona Vaisbuch; Nikolas H Blevins; John S Oghalai; Alex D Sweeney; Marlan R Hansen; Bruce J Gantz; Rick F Nelson; Joe Walter Kutz; Brandon Isaacson; Moises A Arriaga; Sam Maghami; Richard L Amdur; Huan Zhang; Samuel H Selesnick; Robert K Jackler

doi:10.1227/neu.0000000000004200

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Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study-Part II- Tumor Regrowth

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Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study-Part II- Tumor Regrowth

Ashkan Monfared, Richard K Gurgel, Philip V Theodosopoulos, Thomas L Haupt, Ronald E Warnick, Parisa Sabetrasekh, Carleton Eduardo Corrales, Yona Vaisbuch, Nikolas H Blevins, John S Oghalai, …

Neurosurgery

09/09/2026

DOI: 10.1227/neu.0000000000004200

PMID: 42714141

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Abstract

Subtotal resection (STR) of large vestibular schwannomas (VS) may achieve better facial nerve outcomes. However, this approach, involving less-than-total tumor removal, may also increase the risk of regrowth. The objective was to examine differences in the regrowth rate based on the extent of resection in patients with large VS. A multicenter, prospective, nonrandomized cohort study was conducted on patients with large VS (≥2.5 cm) who underwent gross total resection (GTR), near-total resection (NTR), or STR. GTR was defined as no visible remnant, NTR as a remnant <0.5 cm3 on postoperative MRI or 5 × 5 × 2 mm during surgery, and STR as any larger remnant. A Cox proportional hazard model assessed the risk of tumor regrowth. Among 126 patients (mean follow-up: 60 ± 31 months; mean tumor diameter: 3.3 ± 0.7 cm), 35 underwent GTR, 39 NTR, and 52 STR. Tumor regrowth occurred in 22 cases (17%). STR patients (27%) had a 3-fold higher regrowth risk compared with GTR patients (8%) (P = .02). The median regrowth time for STR (24 months) was significantly shorter than for NTR or GTR (48 months, P = .03). A greater residual tumor volume percentage (TV%) was associated with regrowth (hazard ratio 1.73, 95% CI, 1.07-2.81, P = .02). A residual tumor volume of 0.7 cm3 and a TV% of 12% were identified as optimal cutoff points for predicting regrowth in NTR. STR is associated with a significantly higher likelihood of tumor regrowth. The percentage of the residual tumor remnant is positively correlated with the risk of regrowth. A residual tumor volume of 0.7 cm3 and a TV% of 12% were identified as optimal cutoffs for NTR. When feasible, GTR or NTR should be attempted to minimize the chances of tumor regrowth.

Subtotal resection of large acoustic neuroma

Tumor regrowth

Acoustic neuroma

Combined therapy acoustic neuroma

Vestibular schwannoma

Details

Title: Subtitle: Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study-Part II- Tumor Regrowth
Creators: Ashkan Monfared - George Washington University
Richard K Gurgel - University of Utah
Philip V Theodosopoulos - University of California, San Francisco
Thomas L Haupt - Kaiser Permanente
Ronald E Warnick - Jewish Hospital
Parisa Sabetrasekh - George Washington University
Carleton Eduardo Corrales - Massachusetts Eye and Ear Infirmary
Yona Vaisbuch - Rambam Health Care Campus
Nikolas H Blevins - Palo Alto University
John S Oghalai - University of Southern California
Alex D Sweeney - Baylor College of Medicine
Marlan R Hansen - University of Iowa
Bruce J Gantz - University of Iowa
Rick F Nelson - Indiana University – Purdue University Indianapolis
Joe Walter Kutz - The University of Texas Southwestern Medical Center
Brandon Isaacson - The University of Texas Southwestern Medical Center
Moises A Arriaga - University Medical Center New Orleans
Sam Maghami - George Washington University
Richard L Amdur - Feinstein Institute for Medical Research
Huan Zhang - University of Iowa
Samuel H Selesnick - Cornell University
Robert K Jackler - Palo Alto University
Resource Type: Journal article
Publication Details: Neurosurgery
DOI: 10.1227/neu.0000000000004200
PMID: 42714141
NLM abbreviation: Neurosurgery
ISSN: 1524-4040
eISSN: 1524-4040
Language: English
Electronic publication date: 09/09/2026
Academic Unit: Molecular Physiology and Biophysics; Neurosurgery; Otolaryngology
Record Identifier: 9985224347702771

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