Objective To date, no European study has compared approach-specific outcome data in vestibular schwannoma (VS) surgery stratified by tumor size. We analyzed hospital length of stay (LOS), intensive therapy/high-dependency unit (ITU/HDU) LOS, and complications in patients undergoing VS surgery via the translabyrinthine (TL) versus retrosigmoid (RS) approaches, stratifying for tumor size. Design Prospective database undergoing retrospective review. Setting Tertiary center. Participants A total of 117 patients with VS undergoing TL ( n = 71) or RS ( n = 46) surgical resection from 2011 to 2016 were analyzed. Data including age, gender, surgical approach, tumor size, hospital, and ITU/HDU LOS and postoperative complications were evaluated. Intervention(s) Therapeutic-VS surgery via either TL or RS approach. Main Outcome Measure(s) LOS (hospital/intensive care unit). Results Hospital LOS was significantly greater in patients undergoing the RS approach versus TL approach in VS between 31 and 40 mm (11 versus 7 days, p < 0.0006). The mean ITU/HDU LOS was greater in the RS group compared with the TL group (4.6 versus 1, p > 0.05). Reported complications were higher in the RS group ( n = 40 versus 22). A post hoc analysis of the 31 to 40 mm group revealed no statistically significant difference in the American Society of Anesthesiologists grade or preoperative performance status. Conclusions In our practice, in VS sized 31 to 40 mm patients stay 4 days longer post RS compared with TL surgery. This translates to £1600 extra per patient in the UK. Our data may inform decision-making during the skull base multidisciplinary team and the consent process to help decide the ideal operative approach for the patient.

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