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<p>In patients with large vestibular schwannomas (VS), surgery is the primary treatment despite risks such as facial nerve dysfunction. Intra-operative monitoring with transcranial motor evoked potentials (TcMEP) helps predict facial nerve outcome but may lead to subtotal resections and later recurrence. This study compares TcMEP thresholds, facial nerve outcome, recurrence rate and progression-free survival in Koos grade 4 vestibular schwannomas. Fifty-five surgically treated patients with Koos grade 4 VS (2015–2024) were included in this retrospective study. All underwent facial nerve TcMEP monitoring. House-Brackmann (HB) scores were assessed postoperatively, and at 6 weeks, 6 months and 1 year. Progression-free survival was analyzed with Kaplan–Meier curves. Postoperatively, 58% showed a decline in facial nerve function. After one year, 83% had good function (HB I–II). A TcMEP threshold increase &lt; 20&#xa0;mA correlated with good outcomes.&#xa0;In 84%&#xa0;(47/55), a small residual tumor remained (mean 0.4 cc; range 0–7.9 cc). Median growth-free&#xa0;survival was 76 months after subtotal resection (STR) and not reached after near-total resection (NTR). We conclude that TcMEP-guided surgery for large vestibular schwannomas provides good&#xa0;facial nerve outcomes, small acceptable remnants and a low long-term recurrence risk. As&#xa0;fewer than half of residual tumors show growth within 8 years, routine postoperative radiotherapy&#xa0;is not recommended; a watchful-waiting strategy is preferred.</p>

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Results of TcMEP guided vestibular schwannoma surgery; long term follow-up and progression free survival

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月7日

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  • Zora A. Gorissen,
  • Juerd Wijntjes,
  • Henricus P. M. Kunst,
  • Mark ter Laan

摘要

In patients with large vestibular schwannomas (VS), surgery is the primary treatment despite risks such as facial nerve dysfunction. Intra-operative monitoring with transcranial motor evoked potentials (TcMEP) helps predict facial nerve outcome but may lead to subtotal resections and later recurrence. This study compares TcMEP thresholds, facial nerve outcome, recurrence rate and progression-free survival in Koos grade 4 vestibular schwannomas. Fifty-five surgically treated patients with Koos grade 4 VS (2015–2024) were included in this retrospective study. All underwent facial nerve TcMEP monitoring. House-Brackmann (HB) scores were assessed postoperatively, and at 6 weeks, 6 months and 1 year. Progression-free survival was analyzed with Kaplan–Meier curves. Postoperatively, 58% showed a decline in facial nerve function. After one year, 83% had good function (HB I–II). A TcMEP threshold increase < 20 mA correlated with good outcomes. In 84% (47/55), a small residual tumor remained (mean 0.4 cc; range 0–7.9 cc). Median growth-free survival was 76 months after subtotal resection (STR) and not reached after near-total resection (NTR). We conclude that TcMEP-guided surgery for large vestibular schwannomas provides good facial nerve outcomes, small acceptable remnants and a low long-term recurrence risk. As fewer than half of residual tumors show growth within 8 years, routine postoperative radiotherapy is not recommended; a watchful-waiting strategy is preferred.