Clinical Outcomes of Salvage Microsurgical Resection after Radiation Therapy for Sporadic Vestibular Schwannomas

Background  The purpose of this study was to evaluate clinical outcomes after salvage microsurgery for vestibular schwannoma (VS) treated initially with modern radiotherapy techniques as compared to those treated with primary microsurgical resection. Methods  Patients who underwent microsurgical resection of sporadic VS undergoing a translabyrinthine approach at a single academic skull base tertiary referral center were included. Baseline and postoperative dynamic gait index, functional gait assessment, House-Brackmann facial nerve grading, and completeness of resection were prospectively recorded. Results  Of the 265 patients reviewed, 21 (7.9%) patients underwent prior radiation. Median age of the cohort was 55 years (interquartile range: 51-63). The likelihood of achieving a gross total resection was significantly lower for radiated as compared to nonradiated patients (odds ratio: 0.18, 95% confidence interval: 0.05-0.53, p  = 0.004) when controlling for tumor size. Radiated patients had better postoperative facial nerve function on the first postoperative day, but this difference was not significant at long-term follow-up. Radiated patients had lower preoperative postural stability scores than nonradiated patients on FGA (26 vs. 23, p  = 0.035). Postoperatively, radiated patients had comparable outcomes compared to nonradiated patients when controlling for age and tumor size. Conclusion  Compared to patients with VS treated with surgery alone, previously radiated patients are less likely to achieve gross total resection in the salvage setting. Radiated patients scored better on facial nerve outcomes compared to nonradiated patients in the initial postoperative period but demonstrated similar long-term outcomes.