Recovery and Discharge Disposition After Retrosigmoid Versus Translabyrinthine Approaches for Vestibular Schwannoma Resection: A Retrospective Review of 301 Patients

The retrosigmoid (RS) and translabyrinthine (TL) approaches are commonly used for vestibular schwannoma resection, each with distinct risks and benefits. This study compared short-term outcomes and recovery between the two approaches.

We retrospectively reviewed 301 patients who underwent vestibular schwannoma resection using the RS (n = 125) or TL (n = 176) at a single institution from 2008 to 2024. Data included demographics, tumor characteristics, surgical details, preoperative symptoms, postoperative complications, length of stay, and discharge disposition. The primary endpoint was home disposition. Secondary endpoints were length of stay and complication rates. Univariable and multivariable logistic regression identified predictors of home disposition.

RS patients had larger tumors (27.0 ± 11.3 mm vs 20.3 ± 8.1 mm, P < .001), higher rates of serviceable hearing (48.4% vs 25.2%, P < .001), and more frequent lumbar drain use (73.6% vs 11.4%, P < .001). TL patients were more often discharged home (82.4% vs 68.8%, P = .006) and had lower rates of postoperative gait imbalance (6.3% vs 19.2%, P < .001), diplopia (0.6% vs 4.8%, P = .016), and cerebrospinal fluid leak requiring repair (9.7% vs 1.6%, P = .005). On multivariable analysis, younger age and smaller tumor size were the only independent predictors of home disposition; surgical approach was not.

TL resection was associated with fewer complications and more frequent discharge to home, but surgical approach did not independently predict recovery. These findings support the use of either approach in selected patients, emphasizing tumor size, comorbidities, and preoperative symptoms in surgical planning.