Optimization of Treatment Protocols in Acoustic Neuroma (Vestibular Schwannoma) Surgery

Acoustic neuroma (vestibular schwannoma) management sits at the intersection of tumor control and long-term function. While these tumors are benign, their location at the cerebellopontine angle and internal auditory canal means that treatment decisions must carefully balance extent of resection with preservation of facial nerve function, hearing, and overall quality of life. In many patients, the goal is not simply “tumor removal,” but durable disease control with the best achievable functional outcome—often determined by patient selection, timing of intervention, and standardized intraoperative and postoperative pathways.

In recent years, surgical practice has evolved from a one-size-fits-all approach toward risk-adapted protocols that incorporate tumor size (e.g., Koos grade), growth behavior, hearing status, patient age/comorbidities, and patient preferences. At the same time, technical advances—such as endoscopy-assisted microsurgery, improved intraoperative neuromonitoring, and image-guided navigation—have expanded the surgeon’s ability to achieve effective tumor management while minimizing neural injury. Despite this progress, there remains substantial variability across centers in decision-making, operative strategy (gross-total vs near-total/subtotal resection with surveillance or adjuvant radiosurgery), neuromonitoring standards, and rehabilitation pathways. This variability makes difficult to compare results and to define best practices that are reproducible and scalable.

This Research Topic focuses on optimization of surgical protocols for acoustic neuroma with an emphasis on functional preservation and patient-centered outcomes. We welcome contributions that advance the evidence base for “how” and “when” to operate, how to standardize pathways, and how to integrate new tools into safe, effective clinical workflows. Submissions may address clinical outcomes, technical refinements, perioperative pathways, or translational innovations that improve decision-making and recovery.

Topics of interest include (but are not limited to):

Risk stratification and protocol-driven decision-making
o Patient selection for surgery versus observation or radiosurgery
o Timing of intervention (including “early” surgery) and outcome trade-offs
o Special populations: NF2-related schwannomas, elderly/frail patients, cystic tumors

Surgical strategies and extent-of-resection paradigms
o Indications and outcomes for gross-total vs near-total/subtotal resection
o Planned subtotal resection with surveillance or adjuvant stereotactic radiosurgery
o Management of residual/recurrent tumor and salvage strategies

Functional preservation techniques
o Facial nerve identification, mapping, and dissection strategies
o Hearing preservation approaches and predictors of success
o Endoscopy-assisted microsurgery and minimally invasive corridor optimization

Advances in intraoperative monitoring and imaging
o Facial nerve EMG, direct stimulation mapping, brainstem auditory monitoring (ABR), and emerging modalities
o Image guidance, high-resolution MRI for IAC/CPA anatomy, and advanced imaging (e.g., tractography) where applicable
o Quality assurance and standardization of neuromonitoring workflows

Robotics and enabling technologies
o Feasibility, safety, workflow integration, and cost-effectiveness of robotic assistance
o Instrumentation innovations and surgeon ergonomics

Postoperative recovery, rehabilitation, and patient-reported outcomes
o Facial reanimation pathways, vestibular rehabilitation, and tinnitus/headache management
o Quality-of-life measures, return-to-work outcomes, and long-term functional trajectories
o Complication reduction pathways (CSF leak, meningitis, hydrocephalus, balance dysfunction)

We encourage prospective and retrospective clinical studies, multicenter registries, systematic reviews/meta-analyses, technical notes with validated outcome reporting, and translational/engineering works with clear clinical relevance. Submissions that adopt standardized outcome metrics (e.g., House–Brackmann for facial nerve function; Gardner–Robertson or AAO-HNS hearing class; PROMs for QoL) are particularly welcome.

Prof. Alberto Feletti holds a patent related to an electrode for endoscopic use and serves as an advisor for MSD

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Acoustic neuroma, Treatment optimization, Minimally invasive surgery, Auditory nerve preservation, Intraoperative neuromonitoring, Surgical robotics, Early intervention, Facial nerve preservation, vestibular schwannoma, hearing preservation, Functional outcome, Postoperative complications

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.