Bicentric analysis of repeated retrosigmoid approach for recurrent vestibular schwannoma: facial nerve function and risk of second recurrence

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BACKGROUND: Surgical retreatment of recurrent vestibular schwannoma (VS) remains challenging, particularly in balancing tumor control with facial nerve (FN) preservation. This bicentric study aimed to evaluate facial nerve outcomes and risk factors for second recurrence following repeated retrosigmoid craniotomy. METHODS: We retrospectively analyzed 35 patients with sporadic VS who underwent repeated retrosigmoid surgery for recurrent VS between 2002 and 2024. Facial nerve function was assessed using the House-Brackmann (HB) grading. Predictors of postoperative FN deterioration at 3-months after repeated surgery and second recurrence were evaluated. RESULTS: FN deterioration occurred in 11 patients (31.4%) at 3-months after repeated surgery. The time between primary and repeated surgery was significantly shorter in patients with postoperative FN deterioration (mean 42.4 vs. 81.2 months, p = 0.008). ROC analysis identified a cut-off of 102 months (AUC = 0.61; 95% CI: 0.42-0.79) for predicting facial nerve preservation. Regarding tumor control, a second recurrence was observed in 4 patients (11.4%). The volumetric extent of resection (EoR) during repeated surgery was significantly associated with second recurrence (p = 0.011). ROC analysis revealed a critical EoR cut-off of 62.0% (AUC = 0.96; 95% CI: 0.89-1.00), with 100% sensitivity and 92.9% specificity. Adjuvant radiotherapy after incomplete resection was not significantly associated with reduced re-recurrence (p = 0.77). CONCLUSIONS: Repeated retrosigmoid surgery for recurrent VS offers favorable tumor control with acceptable facial nerve outcomes. More aggressive VSs with shorter intervals between surgeries may increase the risk of facial nerve deterioration. Local repeated surgery appears to be of importance regarding further tumor control.

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