title: Surgical Treatment of Giant Vestibular Schwannomas: Facial Nerve Outcome and Tumor Control.
abstract: BACKGROUND
  Surgical treatment of giant vestibular schwannomas (GVS) is challenging. The philosophy of incomplete tumor resection may balance the preservation of facial nerve function and long-term tumor control.
  
  
  OBJECTIVE
  We aimed to evaluate the outcome of facial nerve function and tumor control in treating GVS via our institutional surgical strategy.
  
  
  METHODS
  From September 2009 to August 2014, 218 patients who underwent surgical treatment of GVS were enrolled in our study. The clinical features, extent of resections, facial nerve outcome, and the tumor regrowth free rate of these patients were retrospectively analyzed. The treatment strategy of this disease was discussed.
  
  
  RESULTS
  All patients had anatomic preservation of the facial nerve. Gross total resection (GTR) was achieved in 58 patients (28.6%), near-total resection (NTR) in 103 (50.7%), and subtotal resection (STR) in 42 (20.7%). Two patients died because of postoperative complications. After a mean follow-up of 39.7 ± 18.3 months, a favorable facial nerve outcome was achieved in 58.6%, 79.6%, and 83.3% of patients who underwent GTR, NTR, and STR, respectively. During follow-up, 20 patients had tumor regrowth and were treated by stereotactic radiosurgery (SRS), and tumor regrowth free rates were 96.6%, 92.2%, and 76.2% in GTR, NTR, and STR, respectively. The extent of resection was the independent risk factor for poor facial nerve function (P = 0.006).
  
  
  CONCLUSIONS
  A surgical philosophy of prioritizing facial nerve preservation over total tumor resection was recommended in treatment of GVS. Favorable facial nerve outcome and tumor control were achieved after NTR of the tumors.
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Si
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Wenke
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China. Electronic address: zhangsi198712@126.com.
authors.forename: Xuhui
authors.initials: X
authors.lastname: Hui
authors.affiliation: Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Chao
authors.initials: C
authors.lastname: You
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005154:Facial Nerve; D020220:Facial Nerve Injuries / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000532:radiotherapy; D018365:Neoplasm, Residual; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000453:epidemiology; D016634:Radiosurgery; D012044:Regression Analysis; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult
keywords: Giant vestibular schwannoma; Gross total resection; Incomplete resection; Microsurgery; Near-total resection; Vestibular schwannoma