Vestibular schwannoma (vs) surgery: Histological considerations and operative results

In vestibular schwannoma (VS) surgery, understanding of the tumor capsules and nerve-tumor interface is very important to achieve extensive tumor removal while preserving facial and cochlear nerve function. We here demonstrate that tumor capsules of VS consist of thin perineurium of the vestibular nerve and remaining vestibular nerve fibers based on our histological examinations. Also, we show our operative concept of “subcapsular” or “subperineurial” dissection to preserve cranial nerve functions. In this procedure, we place the cleavage plane between the tumor capsules and the tumor parenchyma, which enables us to perform nearly total removal of the tumor by tracing this cleavage plane. Finally, we present our surgical outcomes based on this histological consideration, and conclude that we could increase the possibilities of preserving facial and cochlear nerve functions by performing “subcapsular” or “subperineurial” dissection.