{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T05:12:36Z","timestamp":1778994756273,"version":"3.51.4"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In patients with large vestibular schwannomas (VS), surgery is the primary treatment despite risks such as facial nerve dysfunction. Intra-operative monitoring with transcranial motor evoked potentials (TcMEP) helps predict facial nerve outcome but may lead to subtotal resections and later recurrence. This study compares TcMEP thresholds, facial nerve outcome, recurrence rate and progression-free survival in Koos grade 4 vestibular schwannomas. Fifty-five surgically treated patients with Koos grade 4 VS (2015\u20132024) were included in this retrospective study. All underwent facial nerve TcMEP monitoring. House-Brackmann (HB) scores were assessed postoperatively, and at 6 weeks, 6 months and 1 year. Progression-free survival was analyzed with Kaplan\u2013Meier curves. Postoperatively, 58% showed a decline in facial nerve function. After one year, 83% had good function (HB I\u2013II). A TcMEP threshold increase\u2009&lt;\u200920\u00a0mA correlated with good outcomes.\u00a0In 84%\u00a0(47\/55), a small residual tumor remained (mean 0.4 cc; range 0\u20137.9 cc). Median growth-free\u00a0survival was 76 months after subtotal resection (STR) and not reached after near-total resection (NTR). We conclude that TcMEP-guided surgery for large vestibular schwannomas provides good\u00a0facial nerve outcomes, small acceptable remnants and a low long-term recurrence risk. As\u00a0fewer than half of residual tumors show growth within 8 years, routine postoperative radiotherapy\u00a0is not recommended; a watchful-waiting strategy is preferred.<\/jats:p>","DOI":"10.1007\/s10143-025-04072-1","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T07:39:39Z","timestamp":1770449979000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Results of TcMEP guided vestibular schwannoma surgery; long term follow-up and progression free survival"],"prefix":"10.1007","volume":"49","author":[{"given":"Zora A.","family":"Gorissen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juerd","family":"Wijntjes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henricus P. 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