2006 Clinical Outcomes After Surgery Versus Radiosurgery for 1,345 Cases of Cystic Vestibular Schwannoma

INTRODUCTION: Cystic vestibular schwannoma (cVS) has been shown to have high rates of recurrence and nerve damage after both surgery and stereotactic radiosurgery (SRS). However, cVS studies are few and contradictory, and there is no consensus on optimal treatment strategies. METHODS: Six medical databases were queried according to PRISMA guidelines for articles with primary surgery or SRS for cVS. Clinical outcomes were compared using Wilcoxon and Student’s t-tests. A meta-analysis was performed using random-effects modeling to account for interstudy heterogeneity. RESULTS: 1,345 total patients from 28 studies were included and stratified into two cohorts: 547 SRS and 798 surgical cases. For SRS and surgery, respectively, mean follow-up periods were 65 and 30 months (p=0.01), and pooled tumor control (TC) rates were 92% and 97% (p=0.16). Greater facial nerve (FN) preservation was seen after SRS (98.9%) relative to surgical resection for cVS (84.7%, p<0.01). Hearing preservation was higher after surgery (78.2%) compared to SRS (58.5%), although not significant (p=0.50). Pooled rates of postoperative hydrocephalus requiring a shunt were 2.9% after SRS and 4.9% after surgery (p=0.73). Postoperative mortality was minimal and similar between the cohorts (0.0% SRS, 0.3% surgery). Pooled rates of salvage surgery and SRS were all <3%, with no significant difference between the cohorts (p=0.90, p=0.64, respectively). CONCLUSIONS: Both SRS and surgery are effective treatment modalities for cVS with a low risk of complications. While TC rates are similar between SRS and surgery, SRS may permit greater FN preservation in cVS.