{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T01:13:44Z","timestamp":1789002824505,"version":"build-2803163510"},"reference-count":17,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Staged resection of large vestibular schwannomas (VSs) has been proposed as a strategy to improve facial nerve outcomes and morbidity. The authors report their experience with 2-stage resections of large VSs and analyze the indications, facial nerve outcomes, surgical results, and complications. The authors compare these results with those of a similar cohort of patients who underwent a single-stage resection.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective review of all patients (age &gt; 18 years) who underwent surgery from 2002 to 2010 for large (\u2265 3 cm) VSs at the authors' institution with a minimum of 6 months follow-up was undertaken. A first-stage retrosigmoid approach (without meatal drilling) was performed to remove the cerebellopontine angle portion of the tumor and to decompress the brainstem. A decision to stage the operation was made intraoperatively if there was cerebellar or brainstem edema, excessive tumor adherence to the facial nerve or brainstem, a poorly stimulating facial nerve, or a thinned or splayed facial nerve. A second-stage translabyrinthine approach was performed at a later date to remove the remaining tumor. The single-stage resection consisted of a retrosigmoid approach with meatal drilling. Patient charts were evaluated for tumor size, extent of resection, tumor recurrence, House-Brackmann facial nerve function grade, and complications.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Twenty-eight and 19 patients underwent 2- or single-stage resection of a large VS, respectively. The average tumor size was 3.9 cm (range 3.2\u20137 cm) in the 2-stage group and 3.9 cm (range 3.1\u20135 cm) in the single-stage group. The mean follow-up was 36 \u00b1 19 months in the 2-stage group versus 24 \u00b1 14 months in the single-stage group. Gross-total or near-total resection was achieved in 27 (96.4%) of 28 patients in the 2-stage group and 15 (79%) of 19 patients in the single-stage group (p &lt; 0.01). Anatomical facial nerve preservation was achieved in all but 1 patient (94.7%), and there were no recurrences on follow-up imaging in the 2-stage group. Good facial nerve functional outcome (House-Brackmann Grades I and II) at last follow-up was achieved in 23 (82%) of 28 patients in the 2-stage group and 10 (53%) of 19 patients in the single-stage group (p &lt; 0.01). Cerebrospinal fluid leak\u2013related complications (intracranial hypotension, blood patch, and lumboperitoneal shunt for pseudomeningocele) were more common in the 2-stage group. There were no postoperative strokes, hemorrhages, or deaths in either group.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The authors' results suggest that staged resection of large VSs may potentially achieve better facial nerve outcomes. There does not appear to be added neurological morbidity with staged resections.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.1.jns111402","type":"journal-article","created":{"date-parts":[[2012,2,24]],"date-time":"2012-02-24T15:00:00Z","timestamp":1330095600000},"page":"1126-1133","source":"Crossref","is-referenced-by-count":30,"title":["Staged resection of large vestibular schwannomas"],"prefix":"10.3171","volume":"116","author":[{"given":"Ahmed M.","family":"Raslan","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean O.","family":"McMenomey","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology, Oregon Health & Science University, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnny B.","family":"Delashaw","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology, Oregon Health & Science University, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns111402","series-title":"Neurosurgery","first-page":"785","article-title":"Translabyrinthine removal of large acoustic neuromas","volume":"34","author":"Briggs","year":"1994"},{"key":"b2-jns111402","series-title":"Neurosurgery","first-page":"915","article-title":"Staged removal of acoustic tumors: techniques and lessons learned from a series of 83 patients","volume":"37","author":"Comey","year":"1995"},{"key":"b3-jns111402","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). 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