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Recent Trends in Management of Large Vestibular Schwannomas

Management strategy of large vestibular schwannomas (VS) is still on debate regarding complete removal for tumor control versus incomplete removal for cranial nerve preservation. Still surgery for VS is difficult task for most neurosurgeons to achieve good tumor control rate without neurological sequela. Introduction of radiosurgery has greatly changed therapeutic strategies for large VS, but it has limitations due to large tumor mass. Admist the on-going controversy over optimal therapeutic strategy for large VS, we reviewed literatures for recent trends of therapeutic strategy for large VS. Near-total removal (NTR) and radical sub-total removal (R-STR) followed by radiosurgery showed comparable tumor control rate and favorable facial nerve preservation rate. If preservation of facial nerve is guaranteed, NTR alone is recommended. In case of incomplete surgical resection to save facial nerve integrity, adjuvant radiosurgery is beneficial for tumor control.