title: Microsurgical removal of a vestibular schwannoma after stereotactic radiosurgery: surgical and pathologic findings.
abstract: OBJECTIVE
  The objective of this study was to provide objective evidence of the enhanced difficulty of preserving the facial nerve in patients who need microsurgery after failed stereotactic radiosurgery (SRS) of vestibular schwannoma.
  
  
  METHODS
  This study was a retrospective case review.
  
  
  METHODS
  A tertiary care referral center was the setting for the study.
  
  
  METHODS
  The authors present a case of a young woman with a vestibular schwannoma that enlarged 2 years after treatment with SRS.
  
  
  METHODS
  Microsurgery via the translabyrinthine approach was used.
  
  
  RESULTS
  At surgery, extensive scarring between the facial nerve and tumor capsule was seen, and the nerve could not be identified at all beyond several millimeters proximal to the porus acusticus. Adhesions of the tumor to the ninth and tenth cranial nerves, the brain stem, and the anterior inferior cerebellar artery were also markedly increased. Histologic examination confirmed fibrotic adhesions surrounding the facial nerve.
  
  
  CONCLUSIONS
  The unusual degree of fibrosis, scarring, and adhesions of the tumor to the surrounding structures after SRS made microsurgical removal of the tumor difficult and preservation of the facial nerve impossible.
authors.affiliation: Section of Neurological Surgery, New Jersey Medical School, Newark, USA.
authors.forename: M
authors.initials: M
authors.lastname: Schulder
authors.forename: G S
authors.initials: GS
authors.lastname: Sreepada
authors.forename: J A
authors.initials: JA
authors.lastname: Kwartler
authors.forename: E S
authors.initials: ES
authors.lastname: Cho
mesh_terms: D000328:Adult; D003390:Cranial Nerve Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008866:Microsurgery / Q000379:methods*; D009442:Neurilemmoma / Q000473:pathology* / Q000601:surgery*; D011182:Postoperative Care; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D014725:Vestibular Nerve / Q000473:pathology* / Q000601:surgery*