Subperineural ‘onion-peeling’ dissection for maximizing extent of resection and facial nerve preservation for onco-functional balance in vestibular schwannoma surgery
{"INTRODUCTION:":[0],"Planned":[1],"subtotal":[2],"resection":[3,46,77,107,281],"(STR)":[4],"of":[5,60,91,106,162,177,186,209,214,222],"vestibular":[6],"schwannomas":[7],"(VS)":[8],"followed":[9,140],"by":[10,78,119,141],"stereotactic":[11],"radiosurgery":[12],"(SRS)":[13],"has":[14],"gained":[15],"popularity":[16],"for":[17,278],"minimizing":[18],"facial":[19,39,49,99,116,284,302],"nerve":[20,40,117,285,303],"injury.":[21],"However,":[22],"recurrence":[23,253],"risk":[24],"correlates":[25],"with":[26,42,228,257,305],"residual":[27],"tumor":[28,309],"volume,":[29],"and":[30,54,126,212,225,311],"long-term":[31],"outcomes":[32,41,57,118,189,204,304],"remain":[33],"unknown.":[34],"The":[35,268],"authors":[36],"report":[37],"their":[38,56],"planned":[43],"maximal":[44,279],"safe":[45],"using":[47,82],"a":[48,79,83,88,220,274],"nerve-sparing":[50,276],"subperineural":[51,84,269],"\\"onion-peeling\\"":[52,85,270],"technique,":[53,86],"compare":[55],"to":[58,233,293],"those":[59],"the":[61,98],"hybrid":[62,295],"STR-SRS":[63,296],"approach.":[64],"METHODS:":[65],"A":[66],"retrospective":[67],"study":[68],"was":[69,180,192,219,250,255],"performed":[70],"on":[71],"146":[72],"patients":[73,163],"who":[74],"underwent":[75],"VS":[76,280],"single":[80],"surgeon":[81],"leaving":[87],"thin":[89],"layer":[90],"perineurium":[92],"as":[93],"an":[94,170],"anatomic":[95],"buffer":[96],"overlying":[97],"nerve.":[100],"Tumor":[101,252],"size,":[102],"operative":[103],"approach,":[104],"extent":[105],"(EOR:":[108],"GTR":[109,193,224,258],"100%,":[110],"NTR":[111,195,227,260],"95-99%,":[112],"STR":[113],"<":[114],"95%),":[115],"House-Brackmann":[120],"(HB)":[121],"grade,":[122],"recovery":[123],"time,":[124],"recurrence,":[125,310],"postoperative":[127],"SRS":[128],"usage":[129],"were":[130,135,205],"analyzed.":[131],"RESULTS:":[132],"Most":[133],"tumors":[134],"Koos":[136,210,215,230],"grade":[137,142,231],"III-IV":[138,216],"(69.9%),":[139],"I-II":[143,166,188,203,211],"(30.2%),":[144],"removed":[145],"via":[146],"retrosigmoid":[147],"(86.3%)":[148],"or":[149,194],"translabyrinthine":[150],"(13.7%)":[151],"approaches.":[152],"At":[153],"last":[154],"follow-up":[155,157],"(mean":[156],"=":[158,200,265],"89.8":[159],"months),":[160],"95.2%":[161],"achieved":[164,206],"HB":[165,187,202],"scores":[167],"while":[168,282],"obtaining":[169],"EOR":[171,191],"≥":[172],"95%":[173],"(GTR/NTR)":[174],"in":[175,184,207],"97.3%":[176],"patients.":[178],"There":[179,218],"no":[181],"significant":[182],"difference":[183],"rates":[185],"whether":[190],"(97.8%":[196],"vs.":[197,262],"92.5%,":[198],"p":[199,264],"0.196).":[201],"100%":[208],"93.1%":[213],"tumors.":[217],"trend":[221],"decreased":[223],"increased":[226],"increasing":[229],"I":[232],"IV":[234],"(GTR:":[235],"93.75%,":[236],"86.2%,":[237],"76.9%,":[238],"39.5%;":[239],"NTR:":[240],"6.25%,":[241],"13.8%,":[242],"23.1%,":[243],"55.3%,":[244],"respectively).":[245],"Postoperative":[246],"CSF":[247],"leak":[248],"rate":[249],"2.7%.":[251],"(3.4%)":[254],"lower":[256,308],"than":[259],"(1.1%":[261],"7.5%,":[263],"0.0646).":[266],"CONCLUSION:":[267],"dissection":[271],"technique":[272],"provides":[273],"safe,":[275],"approach":[277,299],"preserving":[283],"function":[286],"thus":[287],"achieving":[288],"excellent":[289],"onco-functional":[290],"outcomes.":[291],"Compared":[292],"historical":[294],"data,":[297],"our":[298],"demonstrated":[300],"favorable":[301],"higher":[306],"EOR,":[307],"less":[312],"radiation":[313],"usage.":[314]}
Authors
- Robert W. Jyung
- Yu‐Lan Mary Ying (ORCID: https://orcid.org/0000-0003-2580-258X)
- K WONG
- James K. Liu (ORCID: https://orcid.org/0000-0002-5952-4082)
- Ahmed Sabra
- Caryn J. Ha
- Yaxel Levin-Carrion
- Sraavya Anne
- Arevik Abramyan
- Vicente Rojas-Navas
Institutions
- Rutgers, The State University of New Jersey (US)
- Saint Barnabas Medical Center (US)
- Pontificia Universidad Católica de Chile (CL)
- Neurosurgeons of New Jersey (US)
- Neurological Surgery (US)
- Rutgers New Jersey Medical School (US)
Publication Details
- Journal
- Journal of Neuro-Oncology
- Published
- 2026-08-25
- DOI
- https://doi.org/10.1007/s11060-026-05755-5
- Primary Topic
- Meningioma and schwannoma management
- Type
- article
- Field-Weighted Citation Impact
- 0.00