Evolution of Vestibular Schwannoma Surgery: the Long Journey to
The extraordinary improvement of patient outcome after surgical treatment for vestibular schwannomas is relatively recent and has occurred mainly over the last 30 years. The introduction of microsurgical techniques has resulted in increasing degrees of precise anatomical and functional preservation of the facial and cochlear nerves. An expanded microsurgical technique accompanied by continuous electrophysiological monitoring has resulted in marked changes in the primary goals for this surgery. Whereas in the past the primary goal of vestibular schwannoma management was to preserve the patient's life, the objective in vestibular schwannoma treatment today is to preserve neurological function.

Long-term follow-up examinations show negligible recurrence rates, indicating that the aim of preservation of nerve function does not limit the completeness of tumor removal with modern neurosurgical techniques. Despite these advances in preserving the anatomical integrity of, for example, the cochlear nerve, losses of function and even deafness may occur postoperatively in some cases. Current biological and technical research in experimental and clinical settings addresses these problems. In this article, the authors report in detail the developments achieved in vestibular schwannoma surgery and the great clinicians to whom these results can be credited.

The overall development of neurosurgery during the last century was accompanied by profound improvements in patient outcome after vestibular schwannoma surgery. Nevertheless, this history was also characterized by extreme and tragic difficulties, including high morbidity and mortality rates.

The achievements in vestibular schwannoma surgery were conspicuously marked by the following advances: 1) a better understanding of the microsurgical anatomy; 2) the current use of the operating microscope; and 3) the significant advances in neuroanesthesia, neurophysiology, and in standard operative techniques during the last 30 years. In this paper we provide an overview of the history of vestibular schwannoma treatment and the milestones that were achieved during this time. For the sake of consistency with historical works, we will often use the term "acoustic neuroma," although many now consider that term obsolete.