Document Type : Research articles


Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China


Background: Acoustic neuroma (AN), also known as vestibular schwannoma, is a benign, generally slow-growing tumor which might result in hearing loss, tinnitus, and disequilibrium. There are currently studies showing that the mean duration from the original operation and the diagnosis of recurrence was 4.2 years and the main recurrent symptoms were intracranial hypertension and walking disorder.
Objectives: This study aimed to investigate the risk factors of postoperative recurrence of acoustic neuroma (AN) and provide a reference for its clinical prevention and treatment.
Methods: This retrospective study included a total of 30 patients with recurrent AN and 23 patients with non-recurrent AN who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China from January 2013 to December 2018. The recurrence rate during the same periods was calculated and surgical treatment was decided according to the tumor size. The surgical effects of the recurrent patients further compared and investigated the way different treatments affected the preservation of the auditory nerve, facial nerve, and posterior group nerve and increased facial paralysis in AN patients.
Results: Univariate analysis of 30 recurrent AN cases showed that tumor size, internal auditory canal invasion, and tumor blood supply are linked to the recurrence of AN (P<0.05). In addition, the multi-factor analysis demonstrated that rich blood supply, medium texture, intratumoral canal invasion, incomplete resection, and large-diameter tumor were independent risk factors for recurrent AN. We observed a significant difference in the preservation of the auditory nerve, but not in the preservation of the facial nerve and posterior nerve, and between the recurrent and non-recurrent AN patients.
Conclusion: This study analyzed the risk factors of postoperative recurrence in patients with acoustic neuroma. The results showed that small size of tumor, tumor blood supply, tumor texture, tumor vascular invasion, and incomplete tumor resection were independent risk factors for recurrent AN patients. Therefore, these factors can be included in the reference indexes, and relevant prevention and treatment measures can also be taken during the operation to reduce the risk of postoperative recurrence.


  1. Mutijiang MA, Ertiza EU, Hao WU, Matili MA, Jiti MI, Guohua ZU, et al. Incidence and risk factors of nausea and vomiting after acoustic neuroma resection via retrosigmoid approach. Clin Neurosurg. 2020;17(1): 100-104.
  2. Karaaslan B. Doğan E. Börcek AÖ. Management of neonatal facial paralysis due to cerebellopontine angle arachnoid cyst: a case report. Pediatr Neurosurg. 2019;54:253-257. doi: 10.1159/000500762.
  3. Chovanec M, Zvěřina E, Profant O, Balogová Z, Kluh J, Syka J, et al. Does anattempt at hearing preservation microsurgery of vestibular schwannoma affect postoperative tinnitus?. Biomed Res Int. 2015;2015:1-9. doi: 10.1155/2015/783169.
  4. Tsao MN, Sahgal A, Xu W, De Salles A, Hayashi M, Levivier M, et al. Stereotactic radiosurgery for vestibular schwannoma: International Stereotactic Radiosurgery Society (ISRS) Practice Guideline. J Radiosurg SBRT. 2017;5(1):5-24. [PubMed: 29296459].
  5. Lihua C, Ruxiang X, Wende L, Bin Y, Kai S, Hao Z, et al. Minimally invasive treatment strategy for acoustic neuroma (analysis of 415 cases). Chin J Neuromed. 2019;3:263-267.
  6. Ho SY, Kveton JF. Acoustic neuroma assessment and management. Otolaryngol Clin North Am. 2002;35:393-404. doi: 10.1016/s0030-6665(02)00004-x. [PubMed: 12391625].
  7. Yihan Y, Yansong Y. Application of dynamic enhanced magnetic resonance in acoustic schwannoma. Chinese Journal of brain diseases and rehabilitation. 2020;10(04):218-224.
  8. Zhao J, Zhang SY, sun HF. Clinical analysis of 89 cases of acoustic schwannoma treated with gamma knife. Chin Med Guide. 2013;11(21):423-424.
  9. Adib SD, Ebner FH, Bornemann A, Hempel JM, Tatagiba M. Surgical Management of Primary Cerebellopontine Angle Melanocytoma: Outcome, Recurrence, and Additional Therapeutic Options. World Neurosurg. 2019;128:835-840. doi: 10.1016/j.wneu.2019.05.004. [PubMed: 31082560].
  10. Jiu W, Xinrui Z, Zhou F. Research progress on timing and applied materials of skull repair. ClinNeurosurg. 2016;13:397.
  11. Guanhua X, Binbin W, Lei X, Yangfan Y, Ning L. Analysis of influencing factors of postoperative complications of acoustic neuroma . Clin Neurosurg. 2020;17(03):327-330.
  12. Tryggvason G, Barnett A, Kim J, Soken H, Maley J, Hansen MR. Radiographic association of schwannomas with sensory ganglia. Otol Neurotol. 201;33(7):1276-82. doi: 10.1097/MAO.0b013e318263d315. [PubMed: 22858714].
  13. Gianoli GJ, Soileau JS. Acoustic neuroma neurophysiologic correlates: vestibular-preoperative, intraoperative, and postoperative. Otolaryngol Clin North Am. 2012;45(2):307-14. doi: 10.1016/j.otc.2011.12.004. [PubMed: 22483818].
  14. Philip R, Prepageran N, Raman R, Jennifer LP, Waran V. Surgical management of large acoustic neuromas: a review. Med J Malaysia. 2009;64(4):294-7. [PubMed: 20954553].
  15. Li ZJ. Effect of unilateral craniotomy with falx cerebri on postoperative GOS score and length of hospital stay in patients with bilateral frontal lobe brain contusion and laceration. Cap Food Me. 2020;4:29.
  16. Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D, et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 2020;22(1):31-45. doi: 10.1093/neuonc/noz153. [PubMed: 31504802].
  17. Ryzenman JM, Pensak ML, Tew JM Jr. Facial paralysis and surgical rehabilitation: a quality of life analysis in a cohort of 1,595 patients after acoustic neuroma surgery. Otol Neurotol. 2005;26(3):516-521. doi: 10.1097/01.mao.0000169786.22707.12. [PubMed: 15891659].
  18. Lee J, Fung K, Lownie SP, Parnes LS. Assessing impairment and disability of facial paralysis in patients with vestibular schwannoma. Arch Otolaryngol Head Neck Surg. 2007;133(1):56-60. doi: 10.1001/archotol.133.1.56. [PubMed : 17224525].
  19. Kim JS, Park IS, Kim SK, Park H, Kang DH, Lee CH, et al. Analysis of the Risk Factors Affecting the Surgical Site Infection after Cranioplasty Following Decompressive Craniectomy. Korean J Neurotrauma. 2015;11(2):100-5. doi: 10.13004/kjnt.2015.11.2.100. [PubMed: 27169073].
  20. Cheng YK, Weng HH, Yang JT, Lee MH, Wang TC, Chang CN. Factors affecting graft infection after cranioplasty.J Clin Neurosci. 2008;15(10):1115-9. doi: 10.1016/j.jocn.2007.09.022. [PubMed: 18656363].
  21. Tanaka Y, Hongo K, Tada T, TKobayashi S. Wllat is the best method for reporting tumor diameter in vestibular schwannoma?. Neurosurgery 2003;53(3):634-638. doi: 10.1227/01.neu.0000080062.61335.a5. [PubMed: 12943580].
  22. Noudel R, Ribeiro T, Roche PH. Microsurgical treatment of intracanalicular vestibular schwannomas. Prog Neurol Surg. 2008;21:183-189. doi: 10.1159/000156916. [PubMed: 18810218].