![]() ![]() ![]() Stereotactic radiosurgery (SRS) is an acceptable option, with similar rates of tumor control and a low risk for permanent facial nerve palsy. Each approach offers different surgical exposures, benefits, and disadvantages. Patients with neurofibromatosis type 2, which is characterized by bilateral VSs, other schwannomas, meningiomas, ependymomas, and ocular abnormalities, are managed differently than those with sporadic unilateral VSs 10 and will not be further discussed due to the scope of this topic.Īdvances in surgical management of VS during the past century have defined lateral skull base approaches that are now applied in the management of other PF and skull base pathologies. 8, 9 Depending on many factors, including patient age, tumor size and growth, and symptomatology, patients can choose surgery, radiation, or conservative management. 6, 7 Studies have revealed suboptimal postsurgical facial nerve function in gross total resection of large VSs. ![]() The goals of VS management have shifted from total resection to functional preservation, particularly when the entire tumor cannot be safely resected with respect to cranial nerve preservation. 3 ⇓– 5 Contrast-enhanced CT of the temporal bones can serve as an alternative if the patient cannot undergo MR imaging. 2 MR imaging is the preferred technique and can provide exquisite tumor characterization, surgical planning, and posttherapeutic evaluation. Imaging can often differentiate VS from other entities such as facial nerve schwannoma, meningioma, epidermoid cyst, arachnoid cyst, aneurysm, and metastasis. Imaging plays a central role in the screening and initial and follow-up assessment of VSs. Symptoms are typically related to compression of adjacent cranial nerves (CNs), brain stem, or posterior fossa (PF) structures. 1 VSs may remain within the internal auditory canal (IAC) or extend into the CPA. Vestibular schwannomas (VSs) are benign neoplasms of the nerve sheath and account for 6%–8% of all intracranial tumors and 80% of cerebellopontine angle (CPA) tumors. ABBREVIATIONS: AAO-HNS American Academy of Otolaryngology-Head and Neck Surgery CN cranial nerve CPA cerebellopontine angle 3D SS-GRE volumetrically acquired steady-state gradient-echo IAC internal auditory canal MF middle fossa craniotomy PF posterior fossa RS retrosigmoid craniotomy SRS stereotactic radiosurgery TL translabyrinthine craniotomy VS vestibular schwannoma ![]()
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