{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:42:42Z","timestamp":1789785762163,"version":"4.0.1"},"reference-count":65,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>In large vestibular schwannoma (VS), microsurgery is the main treatment option, and complete resection is considered the primary goal. However, previous studies have documented suboptimal facial nerve outcomes in patients who undergo complete resection of large VSs. Subtotal resection is likely to reduce the risk of facial nerve injury but increases the risk of lesion regrowth. Gamma Knife surgery (GKS) can be performed to achieve long-term growth control of residual VS after incomplete resection. In this study the authors report on the results in patients treated using planned subtotal resection followed by GKS with special attention to volumetric growth, control rate, and symptoms.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Fifty consecutive patients who underwent the combined treatment strategy of subtotal microsurgical removal and GKS for large VSs between 2002 and 2009 were retrospectively analyzed. Patients with neurofibromatosis Type 2 were excluded. Patient charts were reviewed for clinical symptoms. Audiograms were evaluated to classify hearing pre- and postoperatively. Preoperative and follow-up contrast-enhanced T1-weighted MR images were analyzed using volume-measuring software.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Surgery was performed via a translabyrinthine (25 patients) or retrosigmoid (25 patients) approach. The median follow-up was 33.8 months. Clinical control was achieved in 92% of the cases and radiological control in 90%. One year after radiosurgery, facial nerve function was good (House-Brackmann Grade I or II) in 94% of the patients. One of the two patients who underwent surgery to preserve hearing maintained serviceable hearing after resection followed by GKS.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Considering the good tumor growth control and facial nerve function preservation as well as the possibility of preserving serviceable hearing and the low number of complications, subtotal resection followed by GKS can be the treatment option of choice for large VSs.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.6.jns101958","type":"journal-article","created":{"date-parts":[[2011,8,12]],"date-time":"2011-08-12T12:58:18Z","timestamp":1313153898000},"page":"875-884","source":"Crossref","is-referenced-by-count":111,"title":["Management of large vestibular schwannoma. Part I. Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects"],"prefix":"10.3171","volume":"115","author":[{"given":"Rick","family":"van de Langenberg","sequence":"first","affiliation":[{"name":"Departments of Otolaryngology, Head and Neck Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick E. J.","family":"Hanssens","sequence":"additional","affiliation":[{"name":"Departments of Radiotherapy and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacobus J.","family":"van Overbeeke","sequence":"additional","affiliation":[{"name":"Neurosurgery, Maastricht University Medical Centre;"},{"name":"Neurosurgery, GammaKnife Centre Tilburg, St. Elisabeth Hospital, Tilburg; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen B.","family":"Verheul","sequence":"additional","affiliation":[{"name":"Neurosurgery, GammaKnife Centre Tilburg, St. Elisabeth Hospital, Tilburg; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patty J.","family":"Nelemans","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Statistics, Maastricht University, Maastricht;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert-Jan","family":"de Bondt","sequence":"additional","affiliation":[{"name":"Department of Radiology, Isala Klinieken, Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Stokroos","sequence":"additional","affiliation":[{"name":"Departments of Otolaryngology, Head and Neck Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns101958","series-title":"Otolaryngol Head Neck Surg","first-page":"179","article-title":"Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma)","volume":"113","author":"American Academy of Otolaryngology\u2013Head and Neck Surgery Foundation","year":"1995"},{"key":"b2-jns101958","series-title":"Otolaryngol Head Neck Surg","first-page":"104","article-title":"The fate of the tumor remnant after less-than-complete acoustic neuroma resection","volume":"130","author":"Bloch","year":"2004"},{"key":"b3-jns101958","series-title":"Neurosurgery","first-page":"785","article-title":"Translabyrinthine removal of large acoustic neuromas","volume":"34","author":"Briggs","year":"1994"},{"key":"b4-jns101958","series-title":"Br J Neurosurg","first-page":"547","article-title":"Recurrence of vestibular (acoustic) schwannomas in surgical patients where preservation of facial and cochlear nerve is the priority","volume":"12","author":"Cerullo","year":"1998"},{"issue":"Suppl","key":"b5-jns101958","series-title":"J Neurosurg","first-page":"87","article-title":"Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases","volume":"102","author":"Chung","year":"2005"},{"key":"b6-jns101958","series-title":"Laryngoscope","first-page":"1539","article-title":"Impact of facial paralysis on patients with acoustic neuroma","volume":"110","author":"Cross","year":"2000"},{"key":"b7-jns101958","series-title":"Am J Otol","first-page":"389","article-title":"Recurrence of acoustic neuroma after incomplete resection","volume":"21","author":"El-Kashlan","year":"2000"},{"key":"b8-jns101958","series-title":"Laryngoscope","first-page":"951","article-title":"Conservative management of vestibular schwannomas: an effective strategy","volume":"118","author":"Ferri","year":"2008"},{"key":"b9-jns101958","series-title":"J Neurosurg","first-page":"910","article-title":"Hearing preservation in acoustic neurinoma surgery","volume":"76","author":"Fischer","year":"1992"},{"key":"b10-jns101958","series-title":"Int J Radiat Oncol Biol Phys","first-page":"225","article-title":"Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy","volume":"60","author":"Flickinger","year":"2004"},{"key":"b11-jns101958","series-title":"J Neurosurg","first-page":"657","article-title":"Linear accelerator radiosurgery for vestibular schwannomas","volume":"105","author":"Friedman","year":"2006"},{"key":"b12-jns101958","series-title":"Prog Neurol Surg","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000156709","article-title":"Management of large vestibular schwannomas by combined surgical resection and gamma knife radiosurgery","volume":"21","author":"Fuentes","year":"2008"},{"issue":"5 Suppl","key":"b13-jns101958","series-title":"J Neurosurg","first-page":"644","article-title":"Gamma knife radiosurgery and its possible relationship to malignancy: a review","volume":"97","author":"Ganz","year":"2002"},{"key":"b14-jns101958","series-title":"Otol Neurotol","first-page":"629","article-title":"Surgery for large vestibular schwannoma: residual tumor and outcome","volume":"30","author":"Godefroy","year":"2009"},{"key":"b15-jns101958","series-title":"Clin Otolaryngol Allied Sci","first-page":"409","article-title":"Factors which influence the facial nerve outcome in vestibular schwannoma surgery","volume":"21","author":"Grey","year":"1996"},{"key":"b16-jns101958","series-title":"Neurosurgery","first-page":"257","article-title":"Stereotactic radiosurgery for vestibular schwannomas: analysis of 317 patients followed more than 5 years","volume":"57","author":"Hasegawa","year":"2005"},{"key":"b17-jns101958","series-title":"Laryngoscope","first-page":"1122","article-title":"Hearing preservation after acoustic neuroma resection with tumor size used as a clinical prognosticator","volume":"107","author":"Hecht","year":"1997"},{"key":"b18-jns101958","series-title":"Otolaryngol Head Neck Surg","first-page":"146","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985"},{"issue":"Suppl","key":"b19-jns101958","series-title":"J Neurosurg","first-page":"111","article-title":"Low-dose radiosurgery for large vestibular schwannomas: long-term results of functional preservation","volume":"102","author":"Inoue","year":"2005"},{"key":"b20-jns101958","series-title":"Int J Radiat Oncol Biol Phys","first-page":"75","article-title":"Risk factors for neurological complications after acoustic neurinoma radiosurgery: refinement from further experiences","volume":"48","author":"Ito","year":"2000"},{"key":"b21-jns101958","series-title":"Surg Neurol","first-page":"283","article-title":"Surgery combined with radiosurgery of large acoustic neuromas","volume":"59","author":"Iwai","year":"2003"},{"key":"b22-jns101958","series-title":"Surg Neurol","first-page":"370","article-title":"Current surgical results of retrosigmoid approach in extralarge vestibular schwannomas","volume":"53","author":"Jung","year":"2000"},{"key":"b23-jns101958","series-title":"Acta Neurochir (Wien)","first-page":"127","article-title":"The long-term growth rate of residual acoustic neurinomas","volume":"129","author":"Kameyama","year":"1994"},{"key":"b24-jns101958","series-title":"Acta Neurochir (Wien)","first-page":"206","article-title":"Long-term follow-up of the residual intracanalicular tumours after subtotal removal of acoustic neurinomas","volume":"138","author":"Kameyama","year":"1996"},{"key":"b25-jns101958","series-title":"N Engl J Med","first-page":"1426","article-title":"Long-term outcomes after radiosurgery for acoustic neuromas","volume":"339","author":"Kondziolka","year":"1998"},{"key":"b26-jns101958","series-title":"J Neurosurg","first-page":"506","article-title":"Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas","volume":"88","author":"Koos","year":"1998"},{"key":"b27-jns101958","series-title":"Otolaryngol Head Neck Surg","first-page":"561","article-title":"Facial nerve outcome after acoustic neuroma surgery: a study from the era of cranial nerve monitoring","volume":"111","author":"Lalwani","year":"1994"},{"key":"b28-jns101958","series-title":"J Neurosurg","first-page":"617","article-title":"Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach","volume":"90","author":"Lanman","year":"1999"},{"key":"b29-jns101958","series-title":"Stereotact Funct Neurosurg","first-page":"175","article-title":"Acoustic neuroma: potential benefits of fractionated stereotactic radiosurgery","volume":"69","author":"Lederman","year":"1997"},{"key":"b30-jns101958","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"56","article-title":"Assessing impairment and disability of facial paralysis in patients with vestibular schwannoma","volume":"133","author":"Lee","year":"2007"},{"key":"b31-jns101958","series-title":"AJNR Am J Neuroradiol","first-page":"1165","article-title":"Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery","volume":"12","author":"Linskey","year":"1991"},{"key":"b32-jns101958","series-title":"Acta Neurochir (Wien)","first-page":"317","article-title":"Repeated treatment of vestibular schwannomas after gamma knife radiosurgery","volume":"151","author":"Liscak","year":"2009"},{"issue":"5","key":"b33-jns101958","series-title":"Neurosurg Focus","first-page":"e3","article-title":"Preservation of functional hearing after gamma knife surgery for vestibular schwannoma","volume":"14","author":"Litvack","year":"2003"},{"key":"b34-jns101958","series-title":"Neurosurgery","first-page":"294","article-title":"Gamma knife radiosurgery in younger patients with vestibular schwannomas","volume":"65","author":"Lobato-Polo","year":"2009"},{"key":"b35-jns101958","series-title":"Neurosurgery","first-page":"1436","article-title":"Second tumors after radiosurgery: tip of the iceberg or a bump in the road?","volume":"52","author":"Loeffler","year":"2003"},{"key":"b36-jns101958","series-title":"J Neurosurg","first-page":"422","article-title":"Radical intracapsular removal of acoustic neurinomas. Long-term follow-up review of 11 patients","volume":"74","author":"Lownie","year":"1991"},{"issue":"Suppl","key":"b37-jns101958","series-title":"J Neurosurg","first-page":"195","article-title":"Radiosurgery of vestibular schwannomas: summary of experience in 829 cases","volume":"102","author":"Lunsford","year":"2005"},{"key":"b38-jns101958","series-title":"Otol Neurotol","first-page":"224","article-title":"Translabyrinthine approach for the management of large and giant vestibular schwannomas","volume":"23","author":"Mamikoglu","year":"2002"},{"key":"b39-jns101958","series-title":"Radiother Oncol","first-page":"94","article-title":"Stereotactic radiation therapy for large vestibular schwannomas","volume":"95","author":"Mandl","year":"2010"},{"key":"b40-jns101958","series-title":"Br J Neurosurg","first-page":"419","article-title":"Regrowth of the residual tumour after acoustic neurinoma surgery","volume":"12","author":"Ohta","year":"1998"},{"key":"b41-jns101958","series-title":"J Neurosurg","first-page":"53","article-title":"Linear accelerator radiosurgery for vestibular schwannoma: measuring tumor volume changes on serial three-dimensional spoiled gradient-echo magnetic resonance images","volume":"103","author":"Okunaga","year":"2005"},{"key":"b42-jns101958","series-title":"J Neurooncol","first-page":"167","article-title":"Therapeutic strategy for large vestibular schwannomas","volume":"77","author":"Park","year":"2006"},{"key":"b43-jns101958","series-title":"Prog Neurol Surg","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1159\/000157170","article-title":"Vestibular schwannoma management: an evidence-based comparison of stereotactic radiosurgery and microsurgical resection","volume":"21","author":"Pollock","year":"2008"},{"key":"b44-jns101958","series-title":"Prog Neurol Surg","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1159\/000156904","article-title":"Vestibular schwannoma radiosurgery after previous surgical resection or stereotactic radiosurgery","volume":"21","author":"Pollock","year":"2008"},{"key":"b45-jns101958","series-title":"J Neurosurg","first-page":"944","article-title":"Vestibular schwannoma management. Part I Failed microsurgery and the role of delayed stereotactic radiosurgery","volume":"89","author":"Pollock","year":"1998"},{"key":"b46-jns101958","series-title":"J Neurosurg","first-page":"949","article-title":"Vestibular schwannoma management. Part II Failed radiosurgery and the role of delayed microsurgery","volume":"89","author":"Pollock","year":"1998"},{"key":"b47-jns101958","series-title":"J Neurosurg","first-page":"191","article-title":"Hearing preservation in vestibular schwannoma surgery: what factors influence outcome?","volume":"83","author":"Post","year":"1995"},{"key":"b48-jns101958","series-title":"J Neurosurg","first-page":"745","article-title":"Gamma surgery for vestibular schwannoma","volume":"92","author":"Prasad","year":"2000"},{"key":"b49-jns101958","series-title":"Skull Base","first-page":"109","article-title":"Treatment of large and giant residual and recurrent vestibular schwannomas","volume":"17","author":"Ramina","year":"2007"},{"key":"b50-jns101958","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1536","article-title":"Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas","volume":"74","author":"Rowe","year":"2003"},{"key":"b51-jns101958","series-title":"J Neurosurg","first-page":"527","article-title":"Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients","volume":"105","author":"Samii","year":"2006"},{"key":"b52-jns101958","series-title":"J Neurosurg","first-page":"860","article-title":"Functional outcome after complete surgical removal of giant vestibular schwannomas. Clinical article","volume":"112","author":"Samii","year":"2010"},{"key":"b53-jns101958","series-title":"Neurosurgery","first-page":"11","article-title":"Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them","volume":"40","author":"Samii","year":"1997"},{"key":"b54-jns101958","series-title":"Otol Neurotol","first-page":"980","article-title":"Treatment of residual vestibular schwannoma","volume":"23","author":"Sanna","year":"2002"},{"key":"b55-jns101958","series-title":"Am J Otol","first-page":"857","article-title":"Effectiveness of conservative management of acoustic neuromas","volume":"21","author":"Shin","year":"2000"},{"key":"b56-jns101958","series-title":"J Laryngol Otol","first-page":"673","article-title":"Change in hearing during \u2018wait and scan\u2019 management of patients with vestibular schwannoma","volume":"122","author":"Stangerup","year":"2008"},{"key":"b57-jns101958","series-title":"Otol Neurotol","first-page":"547","article-title":"The natural history of vestibular schwannoma","volume":"27","author":"Stangerup","year":"2006"},{"key":"b58-jns101958","series-title":"Acta Neurochir (Wien)","first-page":"671","article-title":"Radiosurgery of residual and recurrent vestibular schwannomas","volume":"144","author":"Unger","year":"2002"},{"key":"b59-jns101958","series-title":"Neuroradiology","first-page":"517","article-title":"Follow-up assessment of vestibular schwannomas: volume quantification versus two-dimensional measurements","volume":"51","author":"van de Langenberg","year":"2009"},{"key":"b60-jns101958","series-title":"Otol Neurotol","first-page":"338","article-title":"Predictors of volumetric growth and auditory deterioration in vestibular schwannomas followed in a wait and scan policy","volume":"32","author":"van de Langenberg","year":"2011"},{"key":"b61-jns101958","series-title":"J Neurosurg","article-title":"Management of large vestibular schwannoma. Part II. Primary Gamma Knife surgery: radiological and clinical aspects. Clinical article","author":"van de Langenberg"},{"key":"b62-jns101958","series-title":"Otolaryngol Head Neck Surg","first-page":"645","article-title":"Long-term results of the first 500 cases of acoustic neuroma surgery","volume":"124","author":"Wiet","year":"2001"},{"key":"b63-jns101958","series-title":"J Neurol Neurosurg Psychiatry","first-page":"431","article-title":"Evaluation of tumour response after gamma knife radiosurgery for residual vestibular schwannomas based on MRI morphological features","volume":"79","author":"Yang","year":"2008"},{"key":"b64-jns101958","series-title":"Neurosurgery","first-page":"48","article-title":"Repeat gamma knife surgery for regrowth of vestibular schwannomas","volume":"64","author":"Yomo","year":"2009"},{"key":"b65-jns101958","series-title":"J Clin Neurosci","first-page":"405","article-title":"Facial nerve function after excision of large acoustic neuromas via the suboccipital retrosigmoid approach","volume":"12","author":"Zhang","year":"2005"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/5\/article-p875.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/5\/article-p875.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/5\/article-p875.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T02:43:58Z","timestamp":1679885038000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/5\/article-p875.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,11]]},"references-count":65,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2011.6.jns101958","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,11]]}}}