{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:18:43Z","timestamp":1787771923807,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Surgical excision of giant (&gt;4 cm size) vestibular schwannomas (VS) with preservation of facial nerve (FN) function remains a challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Our surgical technique using an extra-arachnoid plane of dissection and limited meatal drilling is described with the goal of improving FN preservation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Surgical results with respect to FN preservation were analyzed for two groups of giant VS patients: Group A\u2013operated between 2002 and 2009 using \u201cstandard\u201d surgical technique, group B\u2014operated between 2009 and 2016 using extra-arachnoidal dissection and limited meatal drilling. All patients had a minimum follow-up of 1 year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results: Group A:<\/jats:title>\n                    <jats:p>\n                      Of the 115 patients, total excision was possible in 103 (89.5%), near-total in 7 (6%), and subtotal in 5 (4.3%) patients. At a &gt;6-month follow-up, 68 (59.1%) patients had good FN function (House-Brackmann [H&amp;B] grades 1\u20132), while 21 (18.3%) patients had poor function (H&amp;B grade 3\u20135). Grade 6 involvement was seen in 26 (22.6%). Five patients had lower cranial nerve impairment necessitating tracheostomy.\n                      <jats:bold>Group B:<\/jats:bold>\n                      Of the 98 patients, total excision was achieved in 70 (71.4%) patients, near-total in 9 (9.2%), and subtotal in 19 (19.4%). Four patients had repeat surgery; 14 underwent gamma-knife radiosurgery. At &gt;6-month follow-up, 78 (79.5%) patients had good FN function (H&amp;B grades 1\u20132), while 20 (20.4%) had poor function (H&amp;B grade 3\u20135).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>With our 'modified' surgical technique of extra-arachnoidal dissection of VS throughout surgery and limited meatal drilling, an improved rate of functional FN preservation was observed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0028-3886.338661","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:38:10Z","timestamp":1708475890000},"page":"115-121","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Extra-Arachnoidal Dissection and Limited Meatal Drilling for Excision of Giant Vestibular Schwannomas"],"prefix":"10.4103","volume":"70","author":[{"given":"Sunil K","family":"Gupta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darpan","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amey","family":"Savardekar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20-20240907","first-page":"103","article-title":"Contemporary surgical management of vestibular schwannomas: Analysis of complications and lessons learned over the past decade","volume":"72","author":"Nonaka","year":"2013","journal-title":"Neurosurgery"},{"key":"R2-20-20240907","first-page":"195","article-title":"Radiosurgery of vestibular schwannomas: Summary of experience in 829 cases","volume":"119","author":"Lunsford","year":"2013","journal-title":"J 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