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Surgery for Vestibular Schwannoma following Stereotactic Radiosurgery

Stereotactic radiosurgery (SRS) for smaller vestibular schwannoma has become the standard of care now. SRS is well tolerated by patients with excellent long‐term tumor outcome[1] with practically no facial nerve morbidity and good hearing control in patients with preserved hearing before SRS. The authors of the article have well described the operative findings and difficulties encountered during surgical excision of post SRS vestibular schwannomas.[1,2] Following radiosurgery, vestibular schwannomas undergo central radio necrosis followed by reduction of tumor size over 1 to 2 years. Transient vestibular schwannoma enlargement following SRS is well documented in 20% of patients due to radiation effects rather than true tumor progression and only observation is recommended rather than surgical excision.[3]