Large and small vestibular schwannomas: same, yet different tumors

Area of Science:

• Neurosurgery
• Otolaryngology
• Oncology

Background:

• Vestibular schwannomas (VS) vary in size and symptoms.
• Treatment strategies differ for large and small VS, with goals of function preservation.
• Understanding presentation and surgical outcomes is crucial for optimal patient management.

Purpose of the Study:

• To compare the clinical presentation and surgical outcomes of large vestibular schwannomas (LTG) versus small vestibular schwannomas (STG).
• To evaluate differences in complications, functional preservation, and tumor control between LTG and STG.

Main Methods:

• Retrospective data collection of surgically treated VS patients.
• Categorization into large tumor group (LTG, ≥4.0 cm) and small tumor group (STG, <1.0 cm).
• Statistical analysis using p < 0.05 to determine significance.

Main Results:

• STG patients more frequently presented with tinnitus and sudden hearing loss.
• LTG had significantly higher rates of subtotal resection (STR), complications, and poorer postoperative facial nerve function and hearing.
• Tumor recurrence/progression rates were not significantly different between LTG and STG.

Conclusions:

• Large and small VS exhibit distinct clinical presentations.
• Despite maximal function-preservation efforts, LTG experienced more unsatisfactory outcomes in facial nerve function and hearing compared to STG.
• Similar tumor control was achieved for both large and small VS.