TIPS AND TRICKS IN SURGICAL TREATMENT OF LARGE VESTIBULAR SCHWANNOMAS

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Vestibular schwannomas (VS) frequently referred to as acoustic neuromas are the most common tumours of the cerebellopontine angle. They are benign, generally slow-growing tumors that arise from the vestibular portion of the eighth cranial nerve. For patients with large vestibular schwannomas or those exhibiting symptoms from the tumor’s mass effect, surgical intervention remains the preferred treatment approach. This paper discusses the surgical management of patients with large vestibular schwannomas operated in our department and emphasizes the use of intraoperative monitoring for preserving facial nerve function. We review the key surgical steps and highlight the importance of preoperative planning, patient position, and the use of microsurgical techniques to optimize the surgical outcome. Gross total resection of large vestibular schwannomas is associated with worse facial nerve outcomes. Our preferred treatment strategy, especially for older patients, is planned subtotal resection followed by periodic imaging evaluation and radiotherapy in cases of documented tumor growth. This approach may lead to superior facial nerve preservation and improved quality of life for individuals with large vestibular schwannomas. Conclusion The optimal treatment approach for vestibular schwannoma remains a subject of debate. Gross total resection has traditionally been the gold standard for large tumors, but this is often accompanied by a higher risk of postoperative facial nerve dysfunction. Planned subtotal resection with the goal of preserving facial nerve function, followed by closed observation is an alternative approach.