The dissection plane in vestibular schwannoma surgery significantly influences facial and cochlear nerve outcomes. Although histological studies demonstrate that the "tumor capsule" represents vestibular nerve perineurium, epicapsular dissection along its outer surface remains prevalent in clinical practice.
✦ The floor
Discussion
Signed responses from readers of the wire.
This technique paper offers a step-by-step procedural reference for neurotologists; it does not provide comparative outcome data, so no evidence-based change in surgical practice is warranted without further study.
Innovations in surgical dissection technique for vestibular schwannoma could improve preservation rates for facial and cochlear nerves, which remain significant sources of post-operative morbidity.
- 01Selective subperineurial dissection is described as a technique to protect cranial nerves during vestibular schwannoma removal.
- 02Primary focus is on preserving facial nerve and cochlear (hearing) nerve function post-operatively.
- 03The paper is a technique description ('how I do it') rather than a controlled outcomes study.
- 04No comparative data are presented; evidence level is expert opinion.
Selective subperineurial dissection can improve facial and cochlear nerve preservation during vestibular schwannoma surgery.
opinionunclear- PMID
- 42176026
- DOI
- 10.1007/s00701-026-06919-y.
- Journal
- Acta Neurochirurgica
- Publication type
- editorial
- Evidence level
- 5
- Population
- Patients undergoing vestibular schwannoma surgery
- Intervention
- Selective subperineurial dissection technique during vestibular schwannoma surgery
Primary outcomes
Facial nerve preservation; Cochlear nerve preservation