Endoscopy-assisted retrosigmoid craniotomy removal of small vestibular schwannomas: curative tumor removal with preservation of function

Abstract

Abstract Background Three primary treatment modalities exist for small vestibular schwannomas (VSs): wait-and-scan, radiosurgery, and tumor removal. We report the outcomes and preservation of function after retrosigmoid small VS removal with endoscopic assistance and clarify the management paradigm for small VSs. Methods Six patients with small VSs who underwent resection through the retrosigmoid approach with endoscope assistance from January 2019 to December 2022 in our department were enrolled in this study. Data on these patients’ age prior to surgery, side of surgery, tumor size, preoperative and postoperative pure tone average, and word recognition scores were acquired, and the surgical outcomes and postoperative complications were evaluated. Results The tumor was first removed by a conventional microscopic procedure with the help of neurophysiological monitoring, and then an endoscope was used to find and remove any residual lesions. Gross-total resection was facilitated using an operative endoscope in 5 patients (83%), with additional tumors visible through the endoscope. All patients (100%) had a House-Brackmann facial nerve grade of II or better at the last follow-up. Among the four patients (67%) who had good preoperative hearing, the hearing was preserved in 3 patients and one patient had poor hearing after surgery. Total resections were achieved in all the patients (100%). Conclusions As a result of a surgical technique that involves endoscopy-assisted craniotomy with intraoperative neurophysiological monitoring, retrosigmoid removal of small VSs can lead to successful curative tumor removal with excellent functional outcomes. Thus, surgical resection should be the first-line treatment for patients with small VSs who can tolerate surgery.