Vestibular schwannoma microsurgery peculiarities for better functional outcome and result comparison.

[INTRODUCTION] Vestibular schwannomas (VS) are surgically challenging due to proximity to critical neurovascular structures. Preservation of facial and cochlear nerve function is essential for quality of life (QoL).

[RESEARCH QUESTION] Does a refined microsurgical technique with extent of tumor resection improve functional outcomes, quality of life, compared to conventional surgery? The need for generally accepted scale of VS removal radicality. ?

[MATERIAL AND METHODS] This retrospective cohort study included 829 patients treated at the Subtentorial Neurooncology Department Romodanov Institute of Neurosurgery (2001-2024). Group 1 (n = 474) underwent conventional surgery; Group 2 (n = 355) received a modified strategy with preoperative CT-MRI planning, intraoperative neuromonitoring, and nerve-sparing dissection. Facial nerve function was assessed using the HB, and QoL with PANQOL in 118 patients with paired data. Authors suggested.

[RESULTS] Group 2 showed significant PANQOL improvements: Pain (+19.5%), Facial Function (+35.6%), General Health (+15.7%), Total Score (+11.1%), with smaller gains in Hearing (+8%), Balance (+4%), and Energy (+2.3%). Cochlear nerve preservation was achieved in 52.7% of patients with functional hearing in Group 2 versus none in Group 1. Total and subtotal resections were more frequent in Group 2 per VSRG, correlating with lower early residual tumor regrowth (mean follow-up 49.5 vs. 159.4 months) and higher QoL.

[DISCUSSION AND CONCLUSION] Individualized planning, nerve monitoring, and nerve-sparing dissection improves early functional outcomes, QoL, and extent of tumor resection. Prospective studies are needed to confirm long-term tumor control.