Single-stage retrosigmoid versus translabyrinthine resection of vestibular schwannomas: impact of tumor volume on surgical, functional, and radiological outcomes.

Authors

Ufuk Erginoglu, Bekir Can Kendirlioglu, Taha Sukru Korkmaz, Zeynep Arzum Uyaniker, Umid Sulaimanov, Cagdas Ataoglu, Irem Uslu, Gökce Hatipoglu Majernik, Abdullah Keles, Abdurrahman Aycan, Huseyin Erdem Ak, Joseph Roche, Mustafa K Baskaya

Published in

Journal of neurosurgery. Pages 1-13. Jul 31, 2026. Epub Jul 31, 2026.

Abstract

In this study, the authors aimed to compare surgical, functional, and radiological outcomes between retrosigmoid (RS) and translabyrinthine (TL) approaches for single-stage vestibular schwannoma (VS) resection, and to evaluate the influence of tumor volume (TV) and anatomical grade.
The data of 283 patients (207 TL and 76 RS) who underwent single-stage resection between 2006 and 2023 were retrospectively reviewed. Outcomes included extent of resection (EOR), facial nerve (FN) function, hearing preservation, radiological findings, functional status (modified Rankin Scale [mRS] score), and hospital metrics. TV was analyzed as a continuous predictor alongside Koos grade. Multivariable regression and two propensity score-matched analyses were adjusted for confounders, including age, hearing status, and tumor burden. Collinearity between TV and Koos grade was excluded.
In Koos grade III and IV tumors, the TL group achieved higher gross-total resection/near-total resection (GTR/NTR; ≥ 95%) than the RS group (84.8% vs 69.6%, p = 0.019) and remained independently associated with improved EOR (adjusted OR [aOR] 4.76, 95% CI 1.74-13.00; p = 0.002), confirmed in propensity score matching. Larger TV was associated with a lower likelihood of GTR/NTR (aOR 0.12 per log-volume increase, p = 0.001). One-year FN preservation among patients with preoperative House-Brackmann (HB) grades I and II was comparable (94.7% for RS and 93.9% for TL; aOR 0.53, p = 0.34). Favorable discharge mRS score (scores 0-2) was more frequent in the TL group in Koos grade III and IV tumors (100% vs 91.1%) and remained independently associated (aOR 94.2, p = 0.010), although limited by quasi-complete separation. In the RS group, larger TV was significantly associated with worse mRS score (p = 0.001). Hearing preservation occurred only with the RS approach (55% in Koos grades I and II, 51.8% in Koos grades III and IV), with regression precluded by complete separation. Postoperative edema (30.4% vs 0.8%, p < 0.001) and gliosis (5.4% vs 0%, p = 0.029) were more frequent with the RS approach compared with the TL approach and remained significant after propensity score matching. In the RS group, greater TV was associated with radiological abnormalities, worse functional status, and rehabilitation discharge (p ≤ 0.026). In the TL group, higher TV was associated with longer operative time and hospital stay (both p < 0.001). Sinus thrombosis and other major complications did not differ significantly.
TV and Koos grade are complementary predictors of VS outcomes. The TL approach achieves higher resection rates and earlier recovery in large tumors, whereas the RS approach preserves hearing but is linked to greater radiological morbidity. These findings support volume- and anatomy-guided surgical planning.

PMID:
42537238
Bibliographic data and abstract were imported from PubMed on 01 Aug 2026.

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