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Audiovestibular symptoms and facial nerve function comparing microsurgery versus SRS for vestibular schwannomas: a systematic review and meta-analysis

  • Review Article - Tumor - Schwannoma
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Abstract

Objective

Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic review and meta-analysis were conducted to compare the outcomes of surgery versus stereotactic radiosurgery (SRS).

Methods

The Cochrane library, PubMed, Embase, and clinicaltrials.gov were searched through 01/2021 to find all studies on surgical and stereotactic procedures performed to treat vestibular schwannoma. Using a random-effects model, pooled odds ratios (OR) and their 95% confidence intervals (CI) comparing post- to pre-intervention were derived for pre-post studies, and pooled incidence of adverse events post-intervention were calculated for case series and stratified by intervention type.

Results

Twenty-one studies (18 pre-post design; three case series) with 987 patients were included in the final analysis. Comparing post- to pre-intervention, both surgery (OR: 3.52, 95%CI 2.13, 5.81) and SRS (OR: 3.30, 95%CI 1.39, 7.80) resulted in greater odds of hearing loss, lower odds of dizziness (surgery OR: 0.10; 95%CI 0.02, 0.47 vs. SRS OR: 0.22; 95%CI 0.05, 0.99), and tinnitus (surgery OR: 0.23; 95%CI 0.00, 37.9; two studies vs. SRS OR: 0.11; 95%CI 0.01, 1.07; one study). Pooled incidence of facial symmetry loss was larger post-surgery (14.3%, 95%CI 6.8%, 22.7%) than post-SRS (7%, 95%CI 1%, 36%). Tumor control was larger in the surgery (94%, 95%CI 83%, 98%) than the SRS group (80%, 95%CI 31%, 97%) for small-to-medium size tumors.

Conclusion

Both surgery and SRS resulted in similar odds of hearing loss and similar improvements in dizziness and tinnitus among patients with vestibular schwannoma; however, facial symmetry loss appeared higher post-surgery.

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Authors and Affiliations

  1. School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA

    Vinod Kumar Yakkala, Renuka Kandikatla, Bhaskar Paliwal, Hoda Elshibiny & Rania A. Mekary

  2. Department of Neurosurgery, Santa Croce e Carle Hospital, Cuneo, Italy

    Marco Mammi

  3. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Nayan Lamba

  4. Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA

    Nayan Lamba

  5. Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    C. Eduardo Corrales

  6. Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Timothy R. Smith & Rania A. Mekary

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Yakkala, V.K., Mammi, M., Lamba, N. et al. Audiovestibular symptoms and facial nerve function comparing microsurgery versus SRS for vestibular schwannomas: a systematic review and meta-analysis. Acta Neurochir 164, 3221–3233 (2022). https://doi.org/10.1007/s00701-022-05338-z

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