Microsurgery after radiosurgery or radiotherapy for vestibular schwannomas.

Radiosurgery or radiotherapy for vestibular schwannomas has become a common practice with a high chance for tumor control. Despite the high rate of tumor control, there are some tumors that cannot be controlled with radiation therapy. Surgical treatment after radiosurgery or radiotherapy may be necessary for tumors that continue to grow, or for patients who develop brainstem compressive symptoms, disabling hemifacial spasm, or hydrocephalus. The House Ear Clinic (Los Angeles, California) experience with microsurgery after irradiation has demonstrated that the facial nerve is different once it has been radiated. An irradiated facial nerve's regeneration potential is diminished, and the recovery from microsurgical trauma is not as robust. It is recommended that patients who require microsurgical excision following radiosurgery or radiotherapy have a more conservative approach compared to non-irradiated cases.