为了在前庭神经鞘瘤（VS）显微手术中保留面神经功能，如果肿瘤与变薄的面神经紧密粘附，一些人主张进行次全切除（STR）。本研究的目的是确定残余量是否与进展相关，以及 STR 期间是否应追求残余量阈值以防止复发。本研究的第二个目的是确定末次随访时的面神经功能是否与切除范围 (EOR) 相关。从 164 例接受切除术的 VS 患者的记录中回顾性收集临床和影像学数据。使用 Visage 测量肿瘤体积，并使用标准统计方法。 House-Brackmann量表用于评估术前和末次随访时面神经功能的变化。61名患者（37%）接受了大体全切除（GTR），103名（63%）接受了STR。中位临床和影像学随访时间分别为 49 个月和 48 个月。 STR 后中位残留体积为 0.5 cm3。 Kaplan-Meier 精算生存分析显示，GTR 后 5 年无进展生存 (PFS) 率为 96.3%，高于 STR 后（84.5%，p = 0.03）。对接受 STR 的患者进行递归分区分析显示，残余体积 0.60 cm3 是复发的最佳阈值。残余体积≥ 0.60 cm3 的患者的 5 年 PFS 为 76.0%，无论辅助 SRS 的情况如何，低于接受残余体积 < 0.60 cm3 的 GTR (96.3%) 或 STR (95.6%) 的患者 (p < 0.01) ）。在 Cox 回归分析中，残余体积≥ 0.60 cm3（HR 14.4，p = 0.01）与进展独立相关，即使考虑到患者年龄、辅助放射外科治疗和术前肿瘤大小也是如此。在最后一次治疗后至少随访 24 个月的 112 名患者中，111 名 (99.1%) 患者在中位最后随访 71 个月时实现了肿瘤控制。最后一次随访时面神经功能较差与 VS 既往治疗独立相关（调整后 OR 3.7，p = 0.04），但与残余体积队列或术前肿瘤体积无关。VS 切除后残余体积 > 0.60 cm3 与 VS 独立相关肿瘤进展，甚至考虑辅助 SRS。这些数据支持在 VS 手术期间最大化 EOR，即使无法安全实现 GTR。

To preserve facial nerve function in vestibular schwannoma (VS) microsurgery, some have advocated subtotal resection (STR) if the tumor is densely adherent to a thinned facial nerve. The objective of this study was to determine if residual volume is associated with progression and whether there is a threshold residual volume that should be pursued during STR to prevent recurrence. A secondary objective of this study was to determine whether facial nerve function at last follow-up was associated with extent of resection (EOR).Clinical and radiographic data were retrospectively collected from the records of 164 patients with VS who underwent resection. Tumor volumes were measured using Visage, and standard statistical methods were used. The House-Brackmann scale was used to assess changes in facial nerve function before surgery and at last follow-up.Sixty-one patients (37%) received gross-total resection (GTR) and 103 (63%) received STR. The median clinical and radiographic follow-ups were 49 and 48 months, respectively. The median residual volume was 0.5 cm3 after STR. Kaplan-Meier actuarial survival analysis revealed a 96.3% 5-year progression-free survival (PFS) rate after GTR, which was greater than that after STR (84.5%, p = 0.03). Recursive partitioning analysis of patients receiving STR revealed a residual volume of 0.60 cm3 as the optimal threshold for recurrence. Patients with residual volume ≥ 0.60 cm3 had a 76.0% 5-year PFS, regardless of adjuvant SRS, which was lower than that for patients undergoing GTR (96.3%) or STR (95.6%) with residual volumes < 0.60 cm3 (p < 0.01). On Cox regression analysis, residual volume ≥ 0.60 cm3 (HR 14.4, p = 0.01) was independently associated with progression, even when accounting for patient age, adjuvant radiosurgery, and preoperative tumor size. In 112 patients with at least 24 months of follow-up after their last treatment, tumor control was achieved in 111 (99.1%) patients at a median last follow-up of 71 months. Worse facial nerve function at the last follow-up was independently associated with prior treatment for VS (adjusted OR 3.7, p = 0.04), but not residual volume cohort or preoperative tumor volume.Residual volume > 0.60 cm3 after VS resection was independently associated with tumor progression, even accounting for adjuvant SRS. These data support maximizing the EOR during VS surgery, even if GTR cannot be safely achieved.