Microsurgical Outcomes in 1,000 Vestibular Schwannoma Patients: A Comprehensive Cohort Analysis

Introduction: Over the past several decades, there has been a decline in the percentage of patients with vestibular schwannomas (VS) who elect microsurgical tumor removal, in part due to perceived risk of facial weakness, subtotal resection, and, when applicable, loss of residual hearing. To add to the growing literature characterizing outcomes, our study summarizes the results of 1,000 consecutive microsurgical VS cases at a high-volume tertiary care center.

Methods: This is a retrospective cohort study of 1,000 patients with VS that underwent microsurgical resection at a single academic tertiary care center under the guidance of a single neurosurgeon and neurotologist between November 2017 and November 2023. Patient and tumor-related characteristics are summarized, and extent of tumor resection, facial nerve function, and postoperative complications are described.

Results: From our preliminary analysis, the median age was 49 years (IQR 40, 58), 63% were female, and 78% were White. Surgical approaches included 44% translabyrinthine (TL), 27% middle cranial fossa (MCF), 24% retrosigmoid (RS), and 5% other. Median tumor dimension was 16 mm (IQR 10, 24), with 52% of tumors being left-sided. Intraoperatively, gross total resection was achieved in 72% of cases, near total resection in 3%, subtotal resection in 21%, and partial resection in 3%. In cases using the MCF or RS approach, CN VIII integrity was maintained in 88%. As the most common postoperative complication, cerebrospinal fluid leak occurred in 9% of cases, and 82% of these were treated with lumbar drain placement. Immediate postoperative House-Brackmann (HB) score I or II was 87% on postop day 1. Hearing preservation rates among applicable MCF and RS cases are currently under study.

Conclusions: This preliminary analysis reveals tumor resection extent, facial nerve outcomes, and complication rates consistent with published studies. The aim is for this extensive patient cohort to become a valuable reference for clinicians involved in the surgical management of VS patients.