Role of Surgery in Vestibular Schwannoma following prior Stereotactic Radiosurgery

Abstract

Stereotactic radiosurgery (SRS) is widely used for treating
vestibular schwannoma (VS), offering high tumour
control rates, especially in small to medium-sized
tumours. However, a subset of patients experiences SRS
failure, requiring subsequent salvage microsurgery (MS).
The primary reason for salvage surgery is continued
tumour growth, but other causes include symptom
progression and cystic enlargement. Salvage surgery is
more challenging due to increased tumour adhesion to
critical structures, resulting in higher complication rates,
particularly for facial nerve preservation. Studies suggest
subtotal resection may offer better outcomes than gross
total resection in terms of facial nerve function, though
treatment remains complex and outcomes vary.
Keywords: Vestibular schwannoma, stereotactic
radiosurgery, salvage surgery, facial nerve.