Microsurgical removal of vestibular schwannomas after failed previous microsurgery

Recurrent and regrowing large vestibular schwannomas (VSs) may require another microsurgical procedure. Little is known about the incidence and the consequences of this second surgical procedure. We reviewed our own 10 reoperated cases during a 20-year period. Eight of them were supposed to have a radical surgery at the initial step, while 2 had experienced a subtotal resection. The mean interval between the 2 surgeries was 8.3 years with an ultra-late recurrent case at 20 years. Additional surgery was justified by a large-sized growing tumor in main cases and/or occurrence of new symptoms. We used a widened translabyrinthine approach in 9 cases and a retrosigmoid route in 1 case. Preservation of a good facial nerve motion (H-B gd I or II) was obtained in 3 out of the 6 cases who displayed this preoperative status. Excluding the facial nerve injury, no major complication was observed in these cases. These results confirm that the iterative surgical procedure for VS carries additional difficulties with respect to functional preservation. Assuming that radiosurgery is an effective tool to control small- to middle-sized VSs, priority was recently given to the facial nerve preservation during the surgical removal of recurrent and regrowing VSs.