Comparative Outcomes of Exoscopic Versus Microscopic Retrosigmoid Vestibular Schwannoma Surgery.

Objective

To compare clinical outcomes of vestibular schwannoma (VS) resection with the operating microscope versus an exoscope. STUDY

Design

Retrospective single-center cohort study.

Setting

Tertiary referral skull base center. PATIENTS A total of 245 adults underwent retrosigmoid VS resection: 103 microscope (2017-2020) and 142 exoscope (2021-2024); exclusions: NF2, revision surgery, and translabyrinthine approaches.

Interventions

Microscope-assisted or exoscope-assisted retrosigmoid VS resection using identical surgical technique and intraoperative neuromonitoring. MAIN OUTCOME MEASURES Operative time; tumor volume; extent of resection; facial nerve continuity and function (House-Brackmann grade at discharge and ≥1-year follow-up); cochlear nerve continuity and hearing preservation; CSF leak and revision surgery rates.

Results

Operative duration was comparable between groups (median: 6.5 vs. 7.0 h; P=0.37). On multivariate analysis, Koos grade was the only significant predictor of duration. Cochlear nerve preservation (38.3% vs. 36.3%), HB I-II at discharge (63.4% vs. 64.1%), facial nerve intraoperative interruption (4.2% vs. 8.7%), nerve reconstruction (4.9% vs. 8.7%), CSF leak, and revision surgery rates were also similar (all P>0.05). At follow-up, the exoscope group showed lower House-Brackmann scores (adjusted OR: 2.54, 95% CI: 1.31-4.94; P=0.006).

Conclusions

Exoscope-assisted retrosigmoid VS resection achieves comparable clinical outcomes to the operating microscope without prolonging operative times. Exoscope adoption, therefore, provides ergonomic and educational advantages without compromising patient outcomes.