Objective : Gross total removal(GTR) without neurological impairments for large vestibular schwannoma(VS) has been challenging to neurosurgeons. The purpose of this study was to evaluate long-term surgical and neurological outcome of attempted subtotal removal(STR) followed by Gamma Knife radiosurgery(GKRS) for VS. Methods : A total of 279 patients, who underwent surgical resection with or without GKRS for VS, were enrolled in this study. The median age and follow-up duration were 45 years(range, 19-73) and 5.5 years(2-15), respectively. Two hundred-forty six cases(88.2%) were in Koos grade 3 or 4. GTR or near total removal(NTR), STR, and partial removal(PR) were achieved in 75(26.9%), 160(57.3%), and 44 patients(15.8%), respectively. Adjuvant GKRS were performed in 124 patients(44.4%). Results : The long-term overall tumor control rate was 91.8%(256/279). Of the 160 patients with STR, the tumor control rate was significantly higher in 86 patients who received GKRS(97.7%) than that in 74 patients who did not undergo GKRS(82.4%; p=0.004). However, the adjuvant GKRS did not significantly influence the tumor control rate in GTR, NTR, and PR groups. The functional preservation rate of facial nerve was significantly higher in the STR or PR groups(188/204; 92.2%) than that in the GTR or NTR groups(56/75; 74.7%; p<0.001). Conclusion : Attempted STR with adjuvant GKRS could acquire excellent tumor control and facial never functional outcome of the patients, who underwent surgery for unilateral sporadic VS.
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