title: Vestibular schwannoma between 1 and 3 cm: importance of the tumor size in surgical and functional outcome.
abstract: OBJECTIVE
  The aim of the study was to compare the surgical and functional outcomes of the microsurgical osteoplastic retro-sigmoid approach in a semi-sitting position in two groups of patients with vestibular schwannomas (VSs) ranging from 1 to 3 cm in size.
  
  
  METHODS
  A 5-year retrospective evaluation was made of these two groups of patients with VS: Patients with VS sizes 1-<2 cm in maximal intra/extrameatal diameter (n=292) were assigned to group "A" and a matched group of patients with VS between 2 and 3 cm in size (n=154) were assigned to group "B".
  
  
  RESULTS
  Significant differences in postoperative outcomes (p<0.05) were found for facial nerve function of House-Brackmann grade I (94% group A vs. 78% group B) and preservation of preoperative hearing (51% group B vs. 34% group A). Patients with tumors sizes ranging between 1 and <2 cm exhibited total tumor removal with significantly higher facial nerve preservation and hearing function preservation rates compared with patients with tumors 2-3 cm in size.
  
  
  CONCLUSIONS
  Even a small increase in tumor size correlated with a significant reduction in good hearing and facial preservation postoperatively, which implies that tumor removal should be performed at the earliest stage possible. Furthermore, these results contradict recommending the wait-and-see approach for intra/extrameatal tumors.
authors.affiliation: Division of Neurosurgery and Skull Base Surgery, St Anna Clinic, Luzern, Switzerland.
authors.forename: Abolghasem
authors.initials: A
authors.lastname: Sepehrnia
authors.affiliation: Department of Neurosurgery, Clemens Hospital, Academic Hospital of Münster University, Düesbergweg 124, 48153 Münster, Germany. Electronic address: shbr61@yahoo.com.
authors.forename: Hamid
authors.initials: H
authors.lastname: Borghei-Razavi
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D005154:Facial Nerve / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Facial nerve functional preservation; Hearing preservation; Retrosigmoid approach; Semi-sitting position; Vestibular schwannoma