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S192: BALANCING TUMOR RESECTION AND FACIAL NERVE FUNCTION IN LARGE VESTIBULAR SCHWANNOMAS: ANALYSIS OF COMPLICATIONS AND OUTCOMES IN A SINGLE-SURGEON COHORT
Arseniy Pichugin¹; Andrey Alekseev¹; Nail Shayakhmetov²; Dilyara Miftakhova²; Daniya Mukhamadieva²; Karina Khayrullina¹; Amadu Konate¹; Roman Ivanov¹; ¹Kazan State Medical University; ²Interregional clinical and diagnostic center

Background: The surgical management of large vestibular schwannomas (VS, Koos Grade 4) aims to maximize tumor resection while preserving cranial nerve function. This study analyzes the surgical outcomes in a consecutive series of patients.

Methods: We conducted a retrospective analysis of 45 patients (29 females, 16 males) with large VS (≥T3a, Koos 4) who underwent surgical resection via the retrosigmoid approach with intraoperative neurophysiological monitoring between 2020 and 2024. The mean patient age was 56.2 years (range 26-75). Preoperatively, 100% of patients had hearing loss on the affected side (anaucusis in 93%, hypacusis in 7%), and 82% had trigeminal nerve involvement.

Results: Total resection was achieved in 4 patients (8.9%), subtotal in 29 (64.4%), and partial (non-complete) in 12 (26.7%). Internal auditory canal drilling was performed in the majority of cases. Postoperative facial nerve function (House-Brackmann scale) at discharge was grade I-II in 18 patients (40%), grade III-IV in 16 (35.6%), and grade V-VI in 11 (24.4%). All patients with total resection experienced significant postoperative facial nerve deficits (HB III-VI). Postoperative complications included cerebellar edema with occlusive hydrocephalus requiring urgent decompression or ventriculostomy in 4 patients (8.9%), ischemic stroke in 1 patient (2.2%), and intracerebral hemorrhage in 1 patient (2.2%). There were no postoperative fatalities or CSF leaks. Adjuvant radiosurgery was recommended or performed in 19 patients (42.2%) for residual or recurrent tumor.

Conclusions: The retrosigmoid approach with neurophysiological monitoring allows for safe and effective resection of large vestibular schwannomas with an acceptable rate of facial nerve preservation. Subtotal resection with functional nerve preservation, followed by radiosurgery for residual tumor, is a viable strategy to achieve optimal long-term outcomes. Total resection, while maximizing tumor control, carries a high risk of significant and permanent facial nerve dysfunction.

 

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