Objective:

To describe a surgical technique for the management of recurrent vestibular schwannomas (VS) using an exo- and endoscopic two-step approach (EETA), highlighting its significance over traditional methods.

Key Findings:

• The EETA provides improved visualization of the internal auditory canal (IAC) and cerebellopontine angle (CPA) compared to traditional methods, with specific metrics demonstrating its effectiveness.
• The technique allows for safe resection of recurrent VS with minimal complications, as evidenced by case studies.
• Two case studies demonstrated successful outcomes with the EETA, including preservation of facial nerve function.

Interpretation:

The EETA is a promising surgical approach for recurrent vestibular schwannomas, enhancing the ability to visualize and excise tumor remnants effectively.

Limitations:

• The technique may require advanced surgical skills and equipment that may not be available in all surgical centers, and potential risks associated with the procedure should be considered.
• Further studies are needed to evaluate long-term outcomes and compare with other surgical techniques.

Conclusion:

The exo- and endoscopic two-step approach offers a valuable method for managing recurrent vestibular schwannomas, improving surgical outcomes and minimizing complications, underscoring its importance in the surgical management of VS.