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S132: OUTCOMES IN MICROSURGICAL MANAGEMENT OF LARGE VESTIBULAR SCHWANNOMAS: A 10-YEAR MICHIGAN EAR INSTITUTE EXPERIENCE
Hyunseo D Jung, MD, MS¹; Joshua D Caskey, MD²; Jeffrey Turnbull, MD²; Bora Agabigum, MD¹; Dennis I Bojrab, MD¹; Seilesh C Babu, MD¹; ¹Michigan Ear Institute; ²Henry Ford Health Neurosurgery

Objective: To compare long-term outcomes in microsurgical management of large vestibular schwannomas (≥2.5cm) with staged vs. single-staged resection with or without adjuvant stereotactic radiosurgery/radiotherapy (SRS/SRT).

Study design: Retrospective case series

Setting: Tertiary referral center

Study Population: The charts of 627 patients with vestibular schwannomas managed with microsurgical resection between 2015 and 2024 at Michigan Ear Institute were reviewed. We identified and included 171 cases that had large tumors (≥2.5cm) managed with microsurgery. 

Intervention(s): Staged or single-stage transtemporal microsurgery with or without adjuvant SRS/SRT.

Main outcome measure(s): Primary outcome is postoperative change in facial nerve function as measured by House-Brackmann (HB) facial nerve grading scale. Secondary outcomes include postsurgical complication rates including CSF leak, meningitis, and prolonged vestibular dysfunction. The effect of adjuvant SRS/SRT on the primary and secondary outcomes was assessed as well. Descriptive statistics were used to compare outcomes to historical controls. Propensity score matched analysis was used to analyze our cohorts controlling for age, tumor size, preoperative HB score, and receipt of SRS. 

Results: 117 patients underwent single stage microsurgical resection (18 with and 99 without adjuvant SRS/SRT), whereas 27 patients were managed with staged resection (7 with and 20 without adjuvant SRS/SRT). Overall, 79% of the total patient cohort had postoperative HB grade of I or II, compared to the 53% reported in the literature for management of large tumors. In both unmatched and matched cohorts, there was no statistically significant difference in postoperative facial nerve function between staged and un-staged strategies. Patients who underwent adjuvant SRS/SRT in either group had an overall higher proportion of normal postoperative facial nerve function compared to the single treatment modality group. There was no difference in rate of postoperative meningitis, wound complications and other cranial neuropathies (excluding CN VII). The single stage group had a higher rate of prolonged vestibular dysfunction. The staged group had a higher rate of CSF leak, although this rate was lower than historical controls reported in the literature.

Conclusion: Large vestibular schwannomas can be treated effectively with either staged or single-staged microsurgery with or without adjuvant SRS/SRT. With judicious decision-making on the role of staged resection, use of stimulating dissectors for intraoperative facial nerve monitoring, and selective use of adjuvant SRT/SRS, large vestibular schwannomas can be managed with improved functional outcomes without compromising tumor control. 

 

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