Background Stereotactic radiosurgery (SRS) and resection are treatment options for patients with facial nerve schwannomas without mass effect. Objective This article evaluates outcomes of patients treated with SRS versus resection + SRS. Method We retrospectively compared 43 patients treated with SRS to 12 patients treated with resection + SRS. The primary study outcome was unfavorable combined endpoint, defined as worsening or new clinical symptoms, and/or tumor radiological progression. SRS (38.81 ± 5.3) and resection + SRS (67.14 ± 11.8) groups had similar clinical follow-ups. Results At the time of SRS, the tumor volumes of SRS (mean ± standard error; 1.83 ± 0.35 mL) and resection + SRS (2.51 ± 0.75 mL) groups were similar. SRS (12.15 ± 0.08 Gy) and resection + SRS (12.16 ± 0.14 Gy) groups received similar radiation doses. SRS group (42/43, 98%) had better local tumor control than the resection + SRS group (10/12, 83%, p = 0.04). Most of SRS (32/43, 74%) and resection + SRS (10/12, 83%) group patients reached a favorable combined endpoint following SRS ( p = 0.52). Considering surgical associated side effects, only 2/10 patients of the resection + SRS group reached a favorable endpoint ( p < 0.001). Patients of SRS group, who are > 34 years old ( p = 0.02), have larger tumors (> 4 mL, 0.04), internal auditory canal (IAC) segment tumor involvement ( p = 0.01) were more likely to reach an unfavorable endpoint. Resection + SRS group patients did not show such a difference. Conclusion While resection is still needed for larger tumors, SRS offers better clinical and radiological outcomes compared to resection followed by SRS for facial schwannomas. Younger age, smaller tumors, and non-IAC situated tumors are factors that portend a favorable outcome.

Department of Neuro Oncology Cleveland Clinic Cleveland Ohio United States

Department of Neurological Surgery Charlottesville Virginia United States

Department of Neurological Surgery House Ear Institute Los Angeles California United States

Department of Neurosurgery Ain Shams University Cairo Egypt

Department of Neurosurgery House Clinic Los Angeles California United States

Department of Neurosurgery National Yang Ming University Hsinchu Taiwan

Department of Neurosurgery New York University Medical Center New York New York United States

Department of Neurosurgery Taipei Veteran General Hospital Taipei Taiwan

Department of Neurosurgery University of Pittsburgh Pittsburgh Pennsylvania United States

Department of Neurosurgery University of Sherbrooke Sherbrooke Quebec Canada

Department of Neurosurgery University of Virginia Charlottesville Virginia United States

Department of Neurosurgery University of Virginia Gamma Knife Surgery Center Charlottesville Virginia United States

Department of Radiation Oncology Mayo Clinic Jacksonville Florida United States

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt

Univ Manitoba Winnipeg Manitoba Canada

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