There are three viable strategies to management of vestibular schwannoma, all with similar functional outcomes. Choice of strategy is usually centre dependent and varies according to access to surgical or high tech radiotherapy services.
Surgery
Surgery for vestibular scwhannoma has existed since before radiotherapy. There are several approaches, which are chosen according to the size of the lesion and function of the vestibulocochlear nerve. Complete surgical resection is usually achievable and recurrence in this population is virtually zero. A small number of patients (< 5%) have subtotal resection and 15% of these will go on to develop symptomatic recurrence.
Surgical outcomes with respect to cranial nerve function are usually good; about 10% of patients develop other cranial nerve abnormalities (usually V or VII related). Hearing is preserved in about 50-60%.
