see also Giant vestibular schwannoma treatment.
They are generally considered to be an indication for microsurgical excision because of the need of immediate surgical decompression and symptom alleviation.The sole exceptions are patients with major comorbidities, in which GKS can be used 1).
However, it must be kept in mind that there is a risk of transient tumor expansion during the following 6 to 18 months after GKS, with subsequent risk of additional clinical deterioration 2) 3).
A combined approach with planned subtotal removal followed by GKS has been increasingly adopted as the main strategy for preserving cranial nerve functions along with long-term tumor control, as a paradigm shift in the past decade 4) 5) 6) 7) 8) 9) 10) 11) 12)
The mechanical stress related with direct dissection can be reduced or avoided in case of subtotal resection and represents the “nerve-centered” tumor surgery approach inherent in this treatment philosophy 13).
Data suggest that large VS management, with planned subtotal resection followed by GKRS, might yield an excellent clinical outcome, allowing the normal facial nerve and a high level of cochlear nerve functions to be retained. Our functional results with this approach in large VS are comparable with those obtained with GKRS alone in small- and medium-sized VS. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control 14). Daniel et al. published a consecutive series of 47 patients.The data showed excellent results in large VS management with a combined approach of microsurgical subtotal resection and GKS on the residual tumor, with regard to the functional outcome and tumor control. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control 15).