Planned subtotal resection (STR) of vestibular schwannomas (VS) followed by stereotactic radiosurgery (SRS) has gained popularity for minimizing facial nerve injury. However, recurrence risk correlates with residual tumor volume, and long-term outcomes remain unknown....
✦ The floor
Discussion
Signed responses from readers of the wire.
Surgeons specializing in vestibular schwannoma may want to review this technique, but audiologists have no direct practice change — monitor for outcomes data from controlled studies before drawing conclusions.
Preserving facial nerve function while maximizing tumor removal in vestibular schwannoma surgery is a longstanding clinical challenge; novel dissection techniques that improve this balance could meaningfully shift surgical decision-making.
- 01Subperineural 'onion-peeling' dissection is described as a technique to maximize vestibular schwannoma resection.
- 02Primary goal is facial nerve preservation alongside maximum tumor removal.
- 03Positioned as an alternative to planned subtotal resection followed by stereotactic radiosurgery.
- 04Published in Journal of Neuro-Oncology.
- 05Technique feasibility and outcomes are described but comparative evidence is lacking.
Subperineural 'onion-peeling' dissection maximizes extent of resection in vestibular schwannoma surgery.
studypartially supportedThis technique preserves facial nerve function better than or comparably to planned subtotal resection plus radiosurgery.
studyunclear- PMID
- 42640504
- DOI
- 10.1007/s11060-026-05755-5.
- Journal
- Journal of Neuro-Oncology
- Publication type
- research_article
- Evidence level
- 4
- Population
- Patients undergoing surgery for vestibular schwannoma
- Intervention
- Subperineural 'onion-peeling' dissection technique
- Comparator
- Planned subtotal resection plus stereotactic radiosurgery
Primary outcomes
Extent of tumor resection; Facial nerve function preservation