title: Near total extirpation of vestibular schwannoma with salvage radiosurgery.
abstract: OBJECTIVE
  The management of a sporadic vestibular schwannoma (VS) has changed with the introduction of stereotactic radiosurgery (SRS). Because functional outcome is important, particularly regarding the facial nerve, a policy of near-total surgical resection of a large-size VS has emerged, minimizing damage to the facial nerve. The debate remains whether the surgical remnant should be treated immediately or after established growth.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  A consecutive cohort of 55 patients underwent a retrosigmoid craniotomy and near-total removal of a large-size VS at our university medical center between 2005 and 2011 and had a follow-up of a least 3 years. Documented growth of the VS remnant after surgery necessitating adjuvant SRS was the primary outcome measure using analysis of variance.
  
  
  RESULTS
  In 45 patients (81.8%), a small tumor remnant was left during surgery. The mean preoperative tumor volume was 12.2 cm(3) (range, 1.13-50.16 cm(3)); the mean volume of the remnant was 0.22 cm(3) (range, 0-1.52 cm(3)). The mean postoperative follow-up time was 35.4 months (range, 3-76 months). Salvage SRS was deemed necessary in seven patients (13.0%). The size of the postoperative tumor remnant was a significant predictor for the necessity of postoperative adjuvant SRS. Normal facial nerve function (House-Brackmann [HB] I) was preserved in 30 patients (57.7%), 17 patients (32.7%) experienced a permanent mild facial nerve deficit (HB II, III), and five patients (9.6%) experienced a severe facial nerve deficit (HB grade IV-VI).
  
  
  CONCLUSIONS
  Initial observation after near total surgical removal of VS is a feasible strategy, with only a minority requiring salvage radiosurgery during follow-up.
authors.affiliation: Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Hanne Rinck
authors.initials: HR
authors.lastname: Jeltema
authors.affiliation: Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Nicolaas A
authors.initials: NA
authors.lastname: Bakker
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Hendrik P
authors.initials: HP
authors.lastname: Bijl
authors.affiliation: Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Wagemakers
authors.affiliation: Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jan D M
authors.initials: JD
authors.lastname: Metzemaekers
authors.affiliation: Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: J Marc C
authors.initials: JM
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Vestibular schwannoma; radiosurgery; retrosigmoid craniotomy