Revision Surgery for Vestibular Schwannomas.

Area of Science:

• Neurosurgery
• Otolaryngology
• Neurotology

Background:

• Vestibular schwannomas are tumors that can recur or remain after initial treatment, necessitating revision surgery.
• Revision surgery for these tumors presents unique challenges, including scar tissue and altered anatomy.
• Understanding clinical outcomes is crucial for managing recurrent or residual vestibular schwannomas.

Purpose of the Study:

• To describe the clinical outcomes of patients undergoing revision surgery for vestibular schwannomas.
• To evaluate the effectiveness of different surgical approaches in revision settings.
• To assess factors influencing facial nerve function and cerebrospinal fluid (CSF) leak rates.

Main Methods:

• Retrospective case series of 234 patients undergoing 250 revision surgeries for vestibular schwannomas between 1985 and 2015.
• Data collected on degree of resection, facial nerve function (House-Brackmann scale), and CSF leaks.
• Analysis of surgical approaches, including translabyrinthine, transcochlear, middle fossa, and retrosigmoid.

Main Results:

• Gross total resection was achieved in 85% of revision surgeries.
• Postoperative facial nerve function was comparable between non-neurofibromatosis type 2 (NF2) and NF2 groups (mean 3.8 vs. 3.9).
• Cerebrospinal fluid (CSF) leaks occurred in 8% of cases, with 2% requiring reoperation.

Conclusions:

• Revision surgery for vestibular schwannomas can achieve high rates of gross total resection.
• The translabyrinthine approach, with potential transcochlear modification, is a preferred method for revision surgery.
• While CSF leak rates are slightly higher than primary surgery, outcomes remain favorable for tumor control and facial nerve preservation.