Surgical approaches to vestibular schwannomas: what the radiologist needs to know

Vestibular schwannomas account for 85% of cerebellopontine angle tumors in adults and most commonly arise from the inferior division of the vestibular nerve. Surgical and imaging techniques have evolved to offer earlier detection and the potential for hearing preservation. Three main surgical techniques are currently being used for the removal of vestibular schwannomas: middle cranial fossa, suboccipital, and translabyrinthine approaches. Each surgical approach has unique advantages and limitations. For example, the middle cranial fossa and suboccipital approaches make hearing preservation possible in selected patients, whereas the translabyrinthine approach precludes hearing preservation because it involves a labyrinthectomy. Imaging plays a key role in preoperative assessment and postoperative management in affected patients. A good understanding of the main surgical approaches, relevant anatomic considerations, surgical complications, and likelihood of tumor recurrence is essential for interpreting magnetic resonance images to the advantage of both the surgeon and the patient, particularly when hearing preservation is a consideration.