Logo image
Back
Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study, Part I-Facial Nerve Outcomes and Degree of Resection
Journal article   Peer reviewed

Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study, Part I-Facial Nerve Outcomes and Degree of Resection

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.0000000000004199
PMID: 42714161

View Online

Abstract

Complete removal of large vestibular schwannomas (VS) poses a significant risk of facial nerve [cranial nerve VII (CNVII)] paralysis. However, less-than-total removal may be associated with an increased risk of regrowth, which could require further treatment with additional risks. The objective was to assess long-term outcomes of postoperative CNVII function in relation to the extent of resection in patients who underwent removal of large VS. A multicenter, prospective, nonrandomized cohort study of patients with large VS (≥2.5 cm) who underwent gross total resection (GTR), near-total resection (NTR), or subtotal resection (STR). GTR was defined as no visible remnant, NTR as a remnant <0.5 cm3 on postoperative MRI, and STR as any larger remnant. CNVII function was evaluated using binary variables: House-Brackmann grades I-II represented excellent-to-good function, whereas House-Brackmann grades III-VI represented fair-to-poor function. A total of 126 patients were included with a mean (SD) follow-up of 60 (±31) months. The mean preoperative tumor diameter was 3.3 ± 0.7 cm. Thirty-five received GTR, 39 received NTR, and 52 received STR based on postoperative MRI. Smaller preoperative tumor size (P = .03) and volume (P = .03) were associated with good immediate CNVII function. Neither immediate nor late facial nerve function was related to the extent of resection. STR was associated with a 3-fold higher surgical failure rate compared with GTR (P = .02), and patients who experienced surgical failure requiring stereotactic radiosurgery or revision surgery had increased odds of fair-to-poor long-term CNVII function (odds ratio 4.6, 95% CI, 1.7-12.5, P = .002). The degree of resection did not predict immediate or late good CNVII function. Surgical failure was associated with worse long-term function. GTR or NTR should be attempted whenever feasible to reduce the likelihood of repeat surgery and poor facial nerve outcomes.
 Facial nerve outcome Subtotal resection of large acoustic neuroma Tumor regrowth Acoustic neuroma Combined therapy acoustic neuroma Vestibular schwannoma

Details

Metrics

1 Record Views
Logo image