ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Radicality and revision surgery in vestibular schwannoma treatment: balancing optimal outcomes with unavoidable necessity.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRevision microsurgery for vestibular schwannoma (VS) after failure of prior microsurgery and/or stereotactic irradiation represents a technically demanding scenario with uncertain functional outcomes. We aimed to evaluate operative strategy, extent of resection, tumor control, and functional results-primarily facial nerve outcomes-in patients undergoing revision VS surgery in a high-volume tertiary center.
methodsA retrospective single-center cohort study included consecutive patients who underwent revision VS microsurgery between 1998 and 2025. Demographic, radiological, surgical, and audiological data were analyzed. Primary endpoint was long-term facial nerve function assessed by House-Brackmann (HB) grading. Secondary endpoints included extent of resection, tumor control on follow-up MRI, hearing outcome, and perioperative morbidity.
resultsNineteen patients (2.6% of 741 treated VS cases) underwent revision surgery. Most tumors were advanced (Koos grade 4, 74%). Gross total resection was achieved in 79%. Immediate postoperative HB VI occurred in 58%, improving over time to 11% at last follow-up. Favorable long-term facial function (HB I-III) was observed in 68%. Hearing preservation was not achieved. Perioperative complications occurred in 42%, most commonly cerebrospinal fluid pseudocyst. Radiological tumor control reached 95% during a mean follow-up of 136 months.
conclusionRevision VS microsurgery provides high rates of tumor control with acceptable facial nerve outcomes but limited hearing preservation. It should be reserved for carefully selected patients and performed in experienced centers with cranial nerve reconstruction expertise.
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