Observation, stereotactic radiosurgery, and microsurgical resection comprise the conventional armamentarium in the management of vestibular schwannomas (VSs).1 The potential to “cure,” as opposed to control tumor growth, is unique to microsurgical resection.
Progress in neuroimaging, permitting more accurate surveillance and refinement of stereotactic radiosurgery, along with a priority shift toward minimizing morbidity, has made partial tumor resection (PTR) attractive as an alternative to gross total resection (GTR). For most patients with VSs, we strive to achieve a GTR. In our practice, judicious use of PTR, in particular near total resection (NTR), is reserved for imminent compromise of facial nerve functional integrity or in cases where a safe GTR is deemed unlikely for reasons related to patient stability or very large tumor size. Below we discuss some of the considerations that inform this position.
Harris MS, Moberly AC, Adunka OF. Partial Resection in Microsurgical Management of Vestibular Schwannomas. JAMA Otolaryngol Head Neck Surg. 2017;143(9):863–864. doi:10.1001/jamaoto.2017.0293
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