Related Experiment Video
Updated: May 29, 2026
A Unified Methodological Framework for Vestibular Schwannoma Research
Published on: June 20, 2017
A paradigm shift in salvage surgery for radiated vestibular schwannoma
Rick A Friedman1, Karen I Berliner, Marc Bassim
1House Clinic and House Research Institute, Los Angeles, California 90057, USA. rfriedman@hei.org
Objective:
Determine whether more conservative management for surgical salvage after failed radiation leads to better facial nerve outcomes.
Study Design:
"Retrospective" review using prospectively planned database.
Setting:
Private practice, tertiary neurotology/neurosurgery referral center.
Patients:
A series of 73 patients with vestibular schwannoma, who underwent primary radiosurgery with no other intervention and then surgical salvage tumor removal using the translabyrinthine approach.
Intervention(S):
Translabyrinthine craniotomy for vestibular schwannoma salvage surgery after failed radiation, with either gross total or partial tumor removal.
Main Outcome Measures:
Long-term (1 yr) House-Brackmann (H-B) facial nerve grade and change in facial nerve grade from before to after surgery.
Results:
Of the 73 patients, 79.5% had gross total removal, 5.5% had planned partial resection (subtotal or near total), and 15.1% had intraoperatively elected partial removal with most of these being near total removal. At 1 year of follow-up, good facial nerve function (H-B I/II) was found in 50% of patients with gross total removal and 85.7% of those with partial removal (p ≤ 0.03). The H-B grade was maintained postoperatively in 45.8% and 78.6% of the 2 groups, respectively (p ≤ 0.037), with 21.7% of the total removal group having unsatisfactory outcomes (H-B V or VI) compared with 7.1% of patients with partial removal. To date, no patient has required additional treatment.
Conclusion:
Failed radiosurgery is an increasing indication for salvage surgery in patients with posterior fossa tumors. A conservative approach with a willingness to perform partial and near-total tumor removals leads to better facial nerve outcomes with no current evidence of treatment compromise.
