Prior surgical resection is a predictor of facial nerve function decrement after radiosurgery for vestibular schwannomas

Pranav Kumar; Jun Ma; Alan Gordillo; Anish Kosanam; Atia Najjar; Juan Alzate; Ksenia Aaron; Pranay Soni; John Suh; Pablo F Recinos; Varun R Kshettry

doi:10.1016/j.clineuro.2026.109361

Prior surgical resection is a predictor of facial nerve function decrement after radiosurgery for vestibular schwannomas

Clin Neurol Neurosurg. 2026 Feb 23:264:109361. doi: 10.1016/j.clineuro.2026.109361. Online ahead of print.

Authors

Pranav Kumar¹, Jun Ma², Alan Gordillo¹, Anish Kosanam¹, Atia Najjar¹, Juan Alzate², Ksenia Aaron³, Pranay Soni⁴, John Suh⁵, Pablo F Recinos⁶, Varun R Kshettry⁷

Affiliations

¹ Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
² Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
⁴ Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁵ Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
⁶ Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
⁷ Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: kshettv@ccf.org.

PMID: 41759480
DOI: 10.1016/j.clineuro.2026.109361

Abstract

Purpose: Gamma Knife radiosurgery (GKRS) can serve as adjunctive treatment for vestibular schwannomas (VS) for residual or recurrent tumor after surgical resection. However, it is poorly understood whether prior surgical resection influences the risk of facial nerve injury from GKRS.

Methods: An institutional database of GKRS treating adult VS was queried for patients with > 2 years of follow-up post-GKRS. Two cohorts were identified: patients with surgical resection prior to GKRS and patients receiving only GKRS. Facial nerve function was graded with the House-Brackmann (HB) scale pre-GKRS and until last follow-up.

Results: There were 31 patients in the surgery-GKRS cohort and 107 in the GKRS-only cohort. The surgery-GKRS cohort had a significantly lower median age (57.1 vs 63.6 years) and higher median tumor volume at time of GKRS (1.96 vs 0.84 cm³). Facial nerve function worsened within 2 years post-GKRS in 7/31 (22.6 %) of surgery-GKRS patients and 7/107 (6.5 %) of GKRS-only patients. At last follow-up, facial nerve function worsened in 5/31 (16.1 %) of surgery-GKRS patients and 3/107 (2.8 %) of GKRS-only patients. After controlling for patient, tumor, and radiosurgical parameters, prior surgical resection was significantly predictive of facial nerve function decrement after GKRS within 2 years and at last follow-up. Larger tumor volume was predictive of facial nerve function decrement at last follow-up. Pre-GK HB score was not predictive of new/worsened facial palsy.

Conclusions: Patients with prior surgical resection may be at increased risk of new or worsened facial paresis after adjuvant or salvage GKRS compared to patients receiving upfront GKRS.

Keywords: Acoustic Neuroma; Facial palsy; Gamma Knife; House-Brackmann; Salvage; Vestibular schwannoma.