OBJECT: Staged resection of large @entity5513 ( @entity5513 ) has been proposed as a strategy to improve facial nerve outcomes and morbidity. The authors report their experience with 2-stage resections of large @entity5513 and analyze the indications, facial nerve outcomes, surgical results, and complications. The authors compare these results with those of a similar cohort of @entity1 who underwent a single-stage resection. METHODS: A retrospective review of all @entity1 (age > 18 years) who underwent surgery from 2002 to 2010 for large (>=  3 cm) @entity5513 at the authors' institution with a minimum of 6 months follow-up was undertaken. A first-stage retrosigmoid approach (without meatal drilling) was performed to remove the cerebellopontine angle portion of the @entity5 and to decompress the brainstem. A decision to stage the operation was made intraoperatively if there was cerebellar or brainstem @entity4 , excessive @entity5 adherence to the facial nerve or brainstem, a poorly stimulating facial nerve, or a thinned or splayed facial nerve. A second-stage translabyrinthine approach was performed at a later date to remove the remaining @entity5 . The single-stage resection consisted of a retrosigmoid approach with meatal drilling. @entity1 charts were evaluated for @entity5 size, extent of resection, @entity5 recurrence, House-Brackmann facial nerve function grade, and complications. RESULTS: Twenty-eight and 19 @entity1 underwent 2- or single-stage resection of a large VS, respectively. The average @entity5 size was 3.9 cm (range 3.2-7 cm) in the 2-stage group and 3.9 cm (range 3.1-5 cm) in the single-stage group. The mean follow-up was 36    19 months in the 2-stage group versus 24    14 months in the single-stage group. Gross-total or near-total resection was achieved in 27 (96.4%) of 28 @entity1 in the 2-stage group and 15 (79%) of 19 @entity1 in the single-stage group (p < 0.01). Anatomical @entity2103 was achieved in all but 1 @entity1 (94.7%), and there were no recurrences on follow-up imaging in the 2-stage group. Good facial nerve functional outcome (House-Brackmann Grades I and II) at last follow-up was achieved in 23 (82%) of 28 @entity1 in the 2-stage group and 10 (53%) of 19 @entity1 in the single-stage group (p < 0.01). @entity5173 ( @entity551 , blood patch, and lumboperitoneal shunt for pseudomeningocele) were more common in the 2-stage group. There were no postoperative @entity64 , @entity548 , or deaths in either group. CONCLUSIONS: The authors' results suggest that staged resection of large @entity5513 may potentially achieve better facial nerve outcomes. There does not appear to be added @entity16 with staged resections.

Staged resection of large XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'Patient'] @entity5513 :: ('MESH:D009464', 'Disease') :: ['VSs', 'vestibular schwannomas'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhages'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity4 :: ('MESH:D004487', 'Disease') :: ['edema'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurological morbidity'] @entity2103 :: ('MESH:D005155', 'Disease') :: ['facial nerve preservation'] @entity5173 :: ('MESH:D065634', 'Disease') :: ['Cerebrospinal fluid leak-related complications'] @entity551 :: ('MESH:D007022', 'Disease') :: ['intracranial hypotension']
@entity5513 :: (MESH:D009464,Disease) :: ['vestibular schwannomas']
