Management of large vestibular schwannomas by combined surgical resection and gamma knife radiosurgery.

In this report, we evaluated the treatment results of a combination of surgery and radiosurgery for large vestibular schwannomas. The series of 8 patients included in this study underwent surgery followed by radiosurgical treatment between January 2000 and January 2006. The patients included 5 males and 3 females aged 24-78 years (mean age: 53 years). The average maximum diameter of the tumor was 40 (35-45) mm. At the time of radiosurgery, the treatment size became 18 (9-20) mm. The mean peripheral dose administered was 11.8 (range 11-13) Gy, and the mean dose administered in the centre of the tumor was 23.75 (22-26) Gy. The mean follow-up period was 46 months after radiosurgery. Excellent facial nerve function (House-Brackmann grade 1 or 2) was preserved in 7/8 patients (87.5%). In the case of large vestibular schwannomas, the combined management is one option for maintaining cranial nerve function and tumor growth control.