Subtotal vs gross total excision of vestibular schwannomas

Vestibular schwannomas are low-grade tumors of the eighth cranial nerve that lead to hearing loss, vestibular dysfunction, and eventual brainstem compression if significant growth occurs. Management of these tumors includes observation, radiosurgery, microsurgical resection, or a combination of these interventions. Although there has been a trend toward treatment with radiosurgery for smaller lesions, consensus reports still advocate for surgical resection in patients with large vestibular schwannomas. There has been a shift in management philosophy toward functional preservation rather than gross total resection, yet subtotal resection of vestibular schwannomas is associated with higher rates of recurrence on follow-up. In this chapter, we review common treatment modalities for VS and surgical indications. Additionally, we directly compare recurrence and complication rates after gross vs subtotal resection.