In order to verify whether a previous gamma knife surgery (GKS) treatment could influence the oncological and functional outcome in large vestibular schwannoma (VS) surgery, we have compared group of patients operated on for large VS after failed GKS to a group of genuine VS that underwent the same functional nerve-sparing resection technique regimen in the same period. Single center retrospective cohort study of 23 consecutive GKS failure and 170 genuine VS patients operated on between April 2003 and March 2019. After resection, patients were allocated to a Wait-&-rescan or an upfront GKS policy. At last follow-up examination, the facial nerve function was good (House-Brackmann grades I or II) in 95% of the GKS failure and 84% of the genuine VS patients (p = .25). The median volume of tumor residue was .56 cc in the GKS failure group and .62 cc in the genuine VS group (p = .70). Tumor control was achieved in 91% and 83% of cases with a mean follow-up of 74 and 63 months in the GKS failure and the genuine VS populations, respectively. The 1-, 5-, and 7-year progression-free survival were 100%, 95%, and 85% respectively in the GKS failure group and 97%, 80%, and 81% in the genuine VS group (p = .27). Despite significant modifications of the microsurgical environment associated to salvage surgery after GKS failure, a functional nerve-sparing resection is an effective strategy to optimize the results on facial nerve function, with similar long-term tumor control to those observed in the genuine VS population.

为了验证先前的伽马刀手术 (GKS) 治疗是否会影响大型前庭神经鞘瘤 (VS) 手术的肿瘤学和功能结果，我们将 GKS 失败后接受大型 VS 手术的患者组与真正的 VS 组进行了比较同期行相同功能性保留神经切除技术方案。单中心回顾性队列研究对 2003 年 4 月至 2019 年 3 月期间 23 例连续 GKS 失败和 170 例真正 VS 患者进行了手术。切除后，患者被分配到等待和重新扫描或预先 GKS 政策。在最后一次随访检查中，95% 的 GKS 失败患者和 84% 的真正 VS 患者的面神经功能良好（House-Brackmann I 或 II 级）（p = .25)。GKS 失败组的肿瘤残留体积中位数为 0.56 cc，真正的 VS 组为 0.62 cc ( p  = .70)。在 GKS 失败和真正的 VS 人群中，91% 和 83% 的病例达到了肿瘤控制，平均随访时间分别为 74 个月和 63 个月。GKS 失败组的 1 年、5 年和 7 年无进展生存率分别为 100%、95% 和 85%，真正 VS 组为 97%、80% 和 81%（p  = . 27)。尽管 GKS 失败后与抢救手术相关的显微手术环境发生了重大改变，但功能性神经保留切除术是优化面神经功能结果的有效策略，其长期肿瘤控制与在真正 VS 人群中观察到的相似。