Clinical Characteristics, Management Patterns, and Surgical Outcomes of Vestibular Schwannoma in a Resource-Limited Setting: A Multicenter Retrospective Cohort Study from Damascus.

BACKGROUND: Vestibular schwannoma is a benign eighth cranial nerve tumor causing morbidity. We characterized tumor features and outcomes in a surgical cohort from Damascus, Syria. METHODS: This multicenter retrospective cohort included 50 patients with histopathologically confirmed vestibular schwannoma who underwent surgery at four hospitals from January 2020 to December 2025. Tumors were classified by diameter as small (≤25 mm), medium (26-35 mm), or large (>35 mm). Preoperative and postoperative outcomes were compared using McNemar tests; associations with tumor size were assessed using chi-square tests. RESULTS: Mean age was 46 ± 13 years (range, 19-72); 32 (64%) were female. Tumors were right-sided in 27 (54%) and left-sided in 23 (46%); 6 (12%) were small, 23 (46%) medium, and 21 (42%) large, 44 (88%) >25 mm. Preoperatively, hearing loss occurred in 46 (92%), balance disturbance in 35 (70%), headache in 29 (58%), tinnitus in 21 (42%), facial numbness/paresthesia in 19 (38%), and facial nerve dysfunction in 11 (22%). Following surgery, these were documented in 32 (64%), 5 (10%), 6 (12%), 2 (4%), 5 (10%), and 30 (60%), respectively (all p < 0.001). No significant associations were found between tumor size and hearing or facial nerve outcomes (p = 0.446-0.913). CONCLUSIONS: Most patients presented with medium or large tumors and morbidity. Following surgery, several symptoms were less frequently documented, whereas facial nerve dysfunction was more frequently documented postoperatively. No significant association between tumor size and hearing or facial nerve outcomes was demonstrated. Findings should be interpreted considering the retrospective design and referral setting.