{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T08:10:11Z","timestamp":1778227811739,"version":"3.51.4"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008678","name":"Universit\u00e4t Leipzig","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008678","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical retreatment of recurrent vestibular schwannoma (VS) remains challenging, particularly in balancing tumor control with facial nerve (FN) preservation. This bicentric study aimed to evaluate facial nerve outcomes and risk factors for second recurrence following repeated retrosigmoid craniotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 35 patients with sporadic VS who underwent repeated retrosigmoid surgery for recurrent VS between 2002 and 2024. Facial nerve function was assessed using the House-Brackmann (HB) grading. Predictors of postoperative FN deterioration at 3-months after repeated surgery and second recurrence were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      FN deterioration occurred in 11 patients (31.4%) at 3-months after repeated surgery. The time between primary and repeated surgery was significantly shorter in patients with postoperative FN deterioration (mean 42.4 vs. 81.2 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). ROC analysis identified a cut-off of 102 months (AUC\u2009=\u20090.61; 95% CI: 0.42\u20130.79) for predicting facial nerve preservation. Regarding tumor control, a second recurrence was observed in 4 patients (11.4%). The volumetric extent of resection (EoR) during repeated surgery was significantly associated with second recurrence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). ROC analysis revealed a critical EoR cut-off of 62.0% (AUC\u2009=\u20090.96; 95% CI: 0.89\u20131.00), with 100% sensitivity and 92.9% specificity. Adjuvant radiotherapy after incomplete resection was not significantly associated with reduced re-recurrence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.77).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Repeated retrosigmoid surgery for recurrent VS offers favorable tumor control with acceptable facial nerve outcomes. More aggressive VSs with shorter intervals between surgeries may increase the risk of facial nerve deterioration. Local repeated surgery appears to be of importance regarding further tumor control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05535-1","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T09:52:10Z","timestamp":1774345930000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bicentric analysis of repeated retrosigmoid approach for recurrent vestibular schwannoma: facial nerve function and risk of second recurrence"],"prefix":"10.1007","volume":"177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4680-0412","authenticated-orcid":false,"given":"Johannes","family":"Wach","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3135-495X","authenticated-orcid":false,"given":"Lisa","family":"Haddad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Vychopen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Arlt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8319-0847","authenticated-orcid":false,"given":"Erdem","family":"G\u00fcresir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Rylewicz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0141ukasz","family":"Przepi\u00f3rka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Przemys\u0142aw","family":"Kunert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"issue":"2","key":"5535_CR1","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s11060-021-03918-0","volume":"156","author":"J Wach","year":"2022","unstructured":"Wach J, G\u00fcresir \u00c1, Borger V, Schuss P, Becker A, Coch C, Schmitz MT, H\u00f6lzel M, Toma M, Herrlinger U, Vatter H, G\u00fcresir E (2022) Elevated baseline C-reactive protein levels predict poor progression-free survival in sporadic vestibular schwannoma. J Neurooncol 156(2):365\u2013375. https:\/\/doi.org\/10.1007\/s11060-021-03918-0","journal-title":"J Neurooncol"},{"issue":"1","key":"5535_CR2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/neuonc\/noz153","volume":"22","author":"R Goldbrunner","year":"2020","unstructured":"Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D, Evans DG, Lefranc F, Sallabanda K, Falini A, Axon P, Sterkers O, Fariselli L, Wick W, Tonn JC (2020) EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol 22(1):31\u201345. https:\/\/doi.org\/10.1093\/neuonc\/noz153","journal-title":"Neuro Oncol"},{"issue":"1","key":"5535_CR3","doi-asserted-by":"publisher","first-page":"4665","DOI":"10.1038\/s41598-021-84319-1","volume":"11","author":"HH Park","year":"2021","unstructured":"Park HH, Park SH, Oh HC, Jung HH, Chang JH, Lee KS, Chang WS, Hong CK (2021) The behavior of residual tumors following incomplete surgical resection for vestibular schwannomas. Sci Rep 11(1):4665. https:\/\/doi.org\/10.1038\/s41598-021-84319-1","journal-title":"Sci Rep"},{"issue":"4","key":"5535_CR4","doi-asserted-by":"publisher","first-page":"e140","DOI":"10.1055\/s-0043-1776124","volume":"84","author":"KR Nandoliya","year":"2023","unstructured":"Nandoliya KR, Winterhalter EJ, Karras CL, Khazanchi R, Youngblood MW, Texakalidis P, Chandler JP, Magill ST (2023) Repeat Surgery for Vestibular Schwannomas: An Institutional Case Series. J Neurol Surg Rep 84(4):e140\u2013e143. https:\/\/doi.org\/10.1055\/s-0043-1776124","journal-title":"J Neurol Surg Rep"},{"issue":"5","key":"5535_CR5","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.3171\/2015.8.JNS151350","volume":"125","author":"M Samii","year":"2016","unstructured":"Samii M, Metwali H, Gerganov V (2016) Microsurgical management of vestibular schwannoma after failed previous surgery. J Neurosurg 125(5):1198\u20131203. https:\/\/doi.org\/10.3171\/2015.8.JNS151350","journal-title":"J Neurosurg"},{"key":"5535_CR6","doi-asserted-by":"publisher","first-page":"850326","DOI":"10.3389\/fneur.2022.850326","volume":"13","author":"F Arlt","year":"2022","unstructured":"Arlt F, Kasper J, Winkler D, J\u00e4hne K, Fehrenbach MK, Meixensberger J, Sander C (2022) Facial Nerve Function After Microsurgical Resection in Vestibular Schwannoma Under Neurophysiological Monitoring. Front Neurol 13:850326. https:\/\/doi.org\/10.3389\/fneur.2022.850326","journal-title":"Front Neurol"},{"issue":"17","key":"5535_CR7","doi-asserted-by":"publisher","first-page":"5319","DOI":"10.3390\/jcm13175319","volume":"13","author":"F Glieme","year":"2024","unstructured":"Glieme F, Haddad L, Arlt F, Vychopen M, Seidel C, Barrantes-Freer A, G\u00fcresir E, Wach J (2024) The Impact of Tumor Elongation on Facial Nerve Outcome after Surgery for Koos Grade 3 and 4 Vestibular Schwannomas in the Semi-Sitting Position via the Retrosigmoid Approach. J Clin Med 13(17):5319. https:\/\/doi.org\/10.3390\/jcm13175319","journal-title":"J Clin Med"},{"issue":"2","key":"5535_CR8","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1177\/019459988509300202","volume":"93","author":"JW House","year":"1985","unstructured":"House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93(2):146\u2013147. https:\/\/doi.org\/10.1177\/019459988509300202","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"8","key":"5535_CR9","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s00234-009-0529-4","volume":"51","author":"R van de Langenberg","year":"2009","unstructured":"van de Langenberg R, de Bondt BJ, Nelemans PJ, Baumert BG, Stokroos RJ (2009) Follow-up assessment of vestibular schwannomas: volume quantification versus two-dimensional measurements. Neuroradiology 51(8):517\u2013524. https:\/\/doi.org\/10.1007\/s00234-009-0529-4","journal-title":"Neuroradiology"},{"issue":"3","key":"5535_CR10","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1177\/0194599818770413","volume":"159","author":"KA Lees","year":"2018","unstructured":"Lees KA, Tombers NM, Link MJ, Driscoll CL, Neff BA, Van Gompel JJ, Lane JI, Lohse CM, Carlson ML (2018) Natural History of Sporadic Vestibular Schwannoma: A Volumetric Study of Tumor Growth. Otolaryngol Head Neck Surg 159(3):535\u2013542. https:\/\/doi.org\/10.1177\/0194599818770413","journal-title":"Otolaryngol Head Neck Surg"},{"key":"5535_CR11","doi-asserted-by":"publisher","first-page":"588260","DOI":"10.3389\/fonc.2020.588260","volume":"10","author":"\u0141 Przepi\u00f3rka","year":"2020","unstructured":"Przepi\u00f3rka \u0141, Kunert P, Rutkowska W, Dziedzic T, Marchel A (2020) Surgery After Surgery for Vestibular Schwannoma: A Case Series. Front Oncol 10:588260. https:\/\/doi.org\/10.3389\/fonc.2020.588260","journal-title":"Front Oncol"},{"issue":"6","key":"5535_CR12","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1016\/j.wneu.2015.02.005","volume":"83","author":"Y Tomita","year":"2015","unstructured":"Tomita Y, Tosaka M, Aihara M, Horiguchi K, Yoshimoto Y (2015) Growth of Primary and Remnant Vestibular Schwannomas: A Three-Year Follow-Up Study. World Neurosurg 83(6):937\u2013944. https:\/\/doi.org\/10.1016\/j.wneu.2015.02.005","journal-title":"World Neurosurg"},{"key":"5535_CR13","doi-asserted-by":"publisher","first-page":"e895","DOI":"10.1016\/j.wneu.2018.07.093","volume":"118","author":"L Troude","year":"2018","unstructured":"Troude L, Boucekine M, Montava M, Lavieille JP, R\u00e9gis JM, Roche PH (2018) Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes. World Neurosurg 118:e895\u2013e905. https:\/\/doi.org\/10.1016\/j.wneu.2018.07.093","journal-title":"World Neurosurg"},{"issue":"4","key":"5535_CR14","doi-asserted-by":"publisher","first-page":"855","DOI":"10.3171\/2008.10.JNS081014","volume":"111","author":"S Di Maio","year":"2009","unstructured":"Di Maio S, Akagami R (2009) Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas. J Neurosurg 111(4):855\u2013862. https:\/\/doi.org\/10.3171\/2008.10.JNS081014","journal-title":"J Neurosurg"},{"key":"5535_CR15","doi-asserted-by":"publisher","unstructured":"Silva J, Cerejo A, Duarte F, Silveira F, Vaz R (2012 May-Jun) Surgical removal of giant acoustic neuromas. World Neurosurg 77(5\u20136):731\u2013735. https:\/\/doi.org\/10.1016\/j.wneu.2011.08.019","DOI":"10.1016\/j.wneu.2011.08.019"},{"issue":"6","key":"5535_CR16","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1097\/MAO.0000000000001402","volume":"38","author":"A Perry","year":"2017","unstructured":"Perry A, Graffeo CS, Copeland WR 3rd, Carlson ML, Neff BA, Driscoll CL, Link MJ (2017) Microsurgery for recurrent vestibular schwannoma after previous gross total resection. Otol Neurotol 38(6):882\u2013888. https:\/\/doi.org\/10.1097\/MAO.0000000000001402","journal-title":"Otol Neurotol"},{"issue":"3","key":"5535_CR17","doi-asserted-by":"publisher","first-page":"E16","DOI":"10.3171\/2012.7.FOCUS12199","volume":"33","author":"RK Gurgel","year":"2012","unstructured":"Gurgel RK, Dogru S, Amdur RL, Monfared A (2012) Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter? Neurosurg Focus 33(3):E16. https:\/\/doi.org\/10.3171\/2012.7.FOCUS12199","journal-title":"Neurosurg Focus"},{"issue":"3","key":"5535_CR18","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1177\/0300060516686873","volume":"45","author":"G Iannella","year":"2017","unstructured":"Iannella G, de Vincentiis M, Di Gioia C, Carletti R, Pasquariello B, Manno A, Angeletti D, Savastano E, Magliulo G (2017) Subtotal resection of vestibular schwannoma: Evaluation with Ki-67 measurement, magnetic resonance imaging, and long-term observation. J Int Med Res 45(3):1061\u20131073. https:\/\/doi.org\/10.1177\/0300060516686873","journal-title":"J Int Med Res"},{"issue":"10","key":"5535_CR19","doi-asserted-by":"publisher","first-page":"698","DOI":"10.2176\/nmc.36.698","volume":"36","author":"M Yokoyama","year":"1996","unstructured":"Yokoyama M, Matsuda M, Nakasu S, Nakajima M, Handa J (1996) Clinical significance of Ki-67 staining index in acoustic neurinoma. Neurol Med Chir (Tokyo) 36(10):698\u2013702 discussion 702-3. https:\/\/doi.org\/10.2176\/nmc.36.698","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"5535_CR20","doi-asserted-by":"publisher","first-page":"e1203","DOI":"10.1016\/j.wneu.2018.09.039","volume":"120","author":"M Panigrahi","year":"2018","unstructured":"Panigrahi M, Kumar D, Vooturi S, Madigubba S (2018) MIB index as predictor of recurrence in sporadic vestibular schwannomas. World Neurosurg 120:e1203\u2013e1207. https:\/\/doi.org\/10.1016\/j.wneu.2018.09.039","journal-title":"World Neurosurg"},{"key":"5535_CR21","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1177\/000348949310201013","volume":"102","author":"S Charabi","year":"1993","unstructured":"Charabi S, Engel P, Jacobsen GK, Tos M, Thomsen J (1993) Growth rate of acoustic neuroma expressed by Ki-67 nuclear antigen versus symptom duration. Ann Otol Rhinol Laryngol 102:805\u2013809. https:\/\/doi.org\/10.1177\/000348949310201013","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"5","key":"5535_CR22","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1007\/s00701-020-04283-z","volume":"162","author":"J Wach","year":"2020","unstructured":"Wach J, Brandecker S, G\u00fcresir A, Schuss P, Vatter H, G\u00fcresir E (2020) The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery. Acta Neurochir (Wien) 162(5):1205\u20131213. https:\/\/doi.org\/10.1007\/s00701-020-04283-z","journal-title":"Acta Neurochir (Wien)"},{"key":"5535_CR23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s40478-019-0760-0","volume":"7","author":"F Behling","year":"2019","unstructured":"Behling F, Ries V, Skardelly M, Gepfner-Tuma I, Schuhmann M, Ebner FH, Tabatabai G, Bornemann A, Schittenhelm J, Tatagiba M (2019) COX2 expression is associated with proliferation and tumor extension in vestibular schwannoma but is not influenced by acetylsalicylic acid intake. Acta Neuropathol Commun 7:105. https:\/\/doi.org\/10.1186\/s40478-019-0760-0","journal-title":"Acta Neuropathol Commun"},{"key":"5535_CR24","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/S0002-9440(10)63338-X","volume":"165","author":"TA Wilgus","year":"2004","unstructured":"Wilgus TA, Bergdall VK, Tober KL, Hill KJ, Mitra S, Flavahan NA, Oberyszyn TM (2004) The impact of cyclooxygenase-2 mediated inflammation on scarless fetal wound healing. Am J Pathol 165:753\u2013761. https:\/\/doi.org\/10.1016\/S0002-9440(10)63338-X","journal-title":"Am J Pathol"},{"key":"5535_CR25","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1093\/neuros\/nyz200","volume":"86","author":"JD Breshears","year":"2020","unstructured":"Breshears JD, Morshed RA, Molinaro AM, McDermott MW, Cheung SW, Theodosopoulos PV (2020) Residual tumor volume and location predict progression after primary subtotal resection of sporadic vestibular schwannomas: a retrospective volumetric study. Neurosurgery 86:410\u2013416. https:\/\/doi.org\/10.1093\/neuros\/nyz200","journal-title":"Neurosurgery"},{"key":"5535_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2016.11.JNS16498","volume":"19","author":"H Nakatomi","year":"2017","unstructured":"Nakatomi H, Jacob JT, Carlson ML, Tanaka S, Tanaka M, Saito N, Lohse CM, Driscoll CLW, Link MJ (2017) Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma. J Neurosurg 19:1\u20137. https:\/\/doi.org\/10.3171\/2016.11.JNS16498","journal-title":"J Neurosurg"},{"key":"5535_CR27","doi-asserted-by":"publisher","first-page":"860","DOI":"10.3171\/2009.7.JNS0989","volume":"112","author":"M Samii","year":"2010","unstructured":"Samii M, Gerganov VM, Samii A (2010) Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 112:860\u2013867. https:\/\/doi.org\/10.3171\/2009.7.JNS0989","journal-title":"J Neurosurg"},{"key":"5535_CR28","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1055\/s-0033-1354379","volume":"92","author":"M Scheich","year":"2013","unstructured":"Scheich M, Ginzkey C, Mlynski R, Hagen R (2013) Postoperative complications after surgery for vestibular schwannoma via the MCF approach. Laryngorhinootologie 92:823\u2013827. https:\/\/doi.org\/10.1055\/s-0033-1354379","journal-title":"Laryngorhinootologie"}],"container-title":["Journal of Neuro-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-026-05535-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11060-026-05535-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-026-05535-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:16:32Z","timestamp":1778224592000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11060-026-05535-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["5535"],"URL":"https:\/\/doi.org\/10.1007\/s11060-026-05535-1","relation":{},"ISSN":["0167-594X","1573-7373"],"issn-type":[{"value":"0167-594X","type":"print"},{"value":"1573-7373","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"assertion":[{"value":"11 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The present study is of retrospective nature and patient informed consent was not needed. This article was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Leipzig (352\/23-ek).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent and institutional review board statement"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"73"}}