(1) To study the overall outcomes of patients surgically treated for large/giant vestibular schwannomas (VSs) and (2) to identify and analyze preoperative and intraoperative prognostic factors influencing facial nerve (FN) outcome. A retrospective clinical study was conducted at a quaternary referral otology and skull-base center. A total of 389 cases were enrolled. The inclusion criteria were patients with tumor > 30 mm undergoing surgery with a minimum follow-up of 12 months. Neurofibromatosis-II, previous radiotherapy, revision surgeries, preoperative FN House-Brackmann (HB) grade > I, partial resections, incomplete records, or those lost to follow-up for a minimum period of 1 year were excluded. In addition, partial resections and cases where FN was sacrificed intraoperatively were also excluded and were analyzed separately. The mean duration of symptoms was 35.4 months, pronounced more in elderly (58.3 months) than in younger individuals (28.4 months). Mean tumor diameter was 36 mm and 52.7% was cystic. Total resection (TR), near total resection (NTR), and subtotal resections (STR) were achieved in 77.4%, 9.5%, and 13.2% of cases, respectively. Regrowth was observed only after STR (19.6%). Good (HB I-II), moderate (HB III), and poor (HB IV-VI) FN functions were observed in 36.8%, 51.7%, and 11.6% cases, respectively. Younger individuals underwent TR in 259 (86.9%) cases against 42 (46.2%) in elderly individuals. Non-total resections (NTR/STR) were performed in 49 (53.8%) cases in elderly as against 39(13.1%) in younger individuals. Good FN outcome was observed in 28 (57.1%) cases of non-total resections in elderly as against 13 (33.3%) cases in younger individuals. On multiple logistic regression analysis, size of the tumor, preoperatively prolonged duration of symptoms, profound deafness, and antero-superiorly located FN with respect to the tumor played a detrimental role in the final facial nerve outcome postoperatively. On the contrary, in large tumors (3–3.9 cm), presence of vertigo/disequilibrium had a relatively better impact on final FN outcome. Partial resections accounted for 41(7.8%) cases and FN was interrupted in 71(13.6%) cases in total. Factors detrimental to better FN outcome were giant VSs (> 4 cm), antero-superiorly located FN intratumorally, preoperatively prolonged duration of symptoms, and profound deafness. In large tumors (3–3.9 cm), presence of vertigo/disequilibrium had a better impact on FN outcome. Understandably, cases with TR in comparison with NTR/STR had worse FN outcomes. In comparison with younger patients, elderly patients underwent higher NTR/STR resulting in better FN outcomes. The above factors can be used as prognosticators for patient counseling and surgical decision making.

(1) 研究大/巨大前庭神经鞘瘤 (VSs) 手术治疗患者的总体结果，以及 (2) 识别和分析影响面神经 (FN) 结果的术前和术中预后因素。在四元转诊耳科和颅底中心进行了一项回顾性临床研究。共纳入 389 例。纳入标准为接受手术且至少随访 12 个月的肿瘤 > 30 mm 的患者。神经纤维瘤病-II、既往放疗、翻修手术、术前 FN House-Brackmann (HB) 等级 > I、部分切除、记录不完整或失访至少 1 年的患者被排除在外。此外，部分切除术和术中牺牲 FN 的病例也被排除在外，分别进行分析。症状的平均持续时间为 35.4 个月，老年人（58.3 个月）比年轻人（28.4 个月）更明显。平均肿瘤直径为 36 毫米，52.7% 为囊性。分别在 77.4%、9.5% 和 13.2% 的病例中实现了全切除 (TR)、接近全切除 (NTR) 和次全切除 (STR)。仅在 STR (19.6%) 后观察到再生。分别在 36.8%、51.7% 和 11.6% 的病例中观察到良好 (HB I-II)、中等 (HB III) 和差 (HB IV-VI) FN 功能。较年轻的个体在 259 (86.9%) 例中接受了 TR，而在老年人中则为 42 (46.2%)。49 例（53.8%）老年人进行了非全切（NTR/STR），而年轻人则为 39 例（13.1%）。在 28 例（57.1%）老年人非完全切除病例中观察到良好的 FN 结果，而在年轻人中则为 13 例（33.3%）。在多元逻辑回归分析中，肿瘤的大小、术前症状持续时间延长、重度耳聋和肿瘤的前上位 FN 对术后最终面神经结果产生不利影响。相反，在大肿瘤（3-3.9 cm）中，眩晕/不平衡的存在对最终 FN 结果的影响相对较好。部分切除41例（7.8%），FN中断71例（13.6%）。不利于更好 FN 结果的因素是巨大的 VS（> 4 cm）、肿瘤内位于前上方的 FN、术前症状持续时间延长和重度耳聋。在大肿瘤（3-3.9 cm）中，眩晕/不平衡的存在对 FN 结果有更好的影响。可以理解的是，与 NTR/STR 相比，TR 病例的 FN 结果更差。与年轻患者相比，老年患者接受更高的 NTR/STR 导致更好的 FN 结果。上述因素可作为患者咨询和手术决策的预测指标。