title: Vestibular schwannoma microsurgery for recurrent tumors after radiation therapy or previous surgical resection.
abstract: OBJECTIVE
  The purpose of this study is to compare the outcomes in patients who underwent microsurgical resection for recurrent vestibular schwannoma after microsurgical resection and previous radiation therapy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifteen patients, who underwent microsurgical resection for recurrent vestibular schwannoma after previous surgery (group A), and 5 patients, who underwent microsurgical resection after previous radiation therapy (group B) were included.
  
  
  METHODS
  Surgical resection after radiation therapy or previous surgical resection.
  
  
  METHODS
  Intraoperative findings and postoperative facial nerve function were investigated in groups A and B.
  
  
  RESULTS
  Mean tumor volumes were 18.4 ± 2.44 cm3 in group A and 19.0 ± 1.53 cm3 in group B. Total resection was achieved in 10 patients (67%) of group A and in 3 patients (60.0%) of group B. The tumor was more difficult to resect because of severe adhesions to the facial nerve. Anatomic facial nerve preservation could be achieved in 19 patients. Mean follow-up time was 80 months for group A and 28 months for group B. At last follow-up, 7 patients (53.8%) of group A had a good facial nerve function. In 3 patients (75.0%) of group B, the preoperative facial nerve function was preserved postoperatively. Preexistent facial paresis, large tumor with extrameatal growth and brainstem compression correlated with poor postoperative facial nerve function.
  
  
  CONCLUSIONS
  Surgical outcome of recurrent vestibular schwannoma is more unsatisfactory than after primary surgery. It remains to be clarified whether previous surgery may implicate a higher risk for postoperative facial nerve function than previous radiation therapy upon surgery for tumor recurrence.
authors: *Department of Neurosurgery, and †Department of Radiation Oncology, Hannover Medical School, Hannover, Germany.
authors: Bujung
authors: B
authors: Hong
authors: Joachim K
authors: JK
authors: Krauss
authors: Michael
authors: M
authors: Bremer
authors: Johann H
authors: JH
authors: Karstens
authors: Hans E
authors: HE
authors: Heissler
authors: Makoto
authors: M
authors: Nakamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000532:radiotherapy / Q000601:surgery*; D016634:Radiosurgery; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult