Microsurgery for Recurrent Vestibular Schwannoma after Previous Gross Total Resection

Objective: To present a single-institution experience and supportive systematic literature review examining outcomes after repeat microsurgery for recurrent vestibular schwannoma (VS) following previous gross total resection (GTR). Study Design: Retrospective review of prospectively maintained VS database. Systematic literature review. Setting: Tertiary referral center. Patients: Six proven VS recurrences after primary GTR, treated via repeat microsurgery. Intervention: Repeat microsurgery. Main Outcome Measures: Facial nerve function, extent-of-resection, time-to-repeat surgery, same versus alternate approach at repeat surgery (relative to primary operation). Results: GTR was achieved in four (67%). House-Brackmann (HB) grade I-II facial nerve function was achieved in five (87%), including one that improved from preoperative HB grade V. An alternate surgical approach was chosen in four (67%). Systematic review identified four studies documenting 50 cases with patient-specific outcomes after repeat microsurgery for recurrent VS. Our cohort had significantly longer mean time-to-repeat surgery (117 vs. 64 months, p = 0.03), was significantly less likely to have HB III-VI function postrepeat (17% vs. 68%, p = 0.04), and was significantly less likely to undergo same approach surgery (33% vs. 90%, p = 0.0002); rates of GTR were nonsignificant (67% vs. 94%, p = 0.1). Conclusion: We report a six-patient series of microsurgery for recurrent VS after GTR, and the first systematic review of this rare and challenging entity. Anecdotally, our findings suggest that an alternate surgical approach may facilitate easier access to the tumor, with less scar encountered during the approach. Our results confirm that repeat microsurgery for recurrent VS is safe and effective, even for larger tumors not typically amenable to stereotactic radiosurgery.