"Salvage surgery for vestibular schwannomas after failed stereotactic radiosurgery or radiation: A systematic review and meta-analysis"

Abstract

Introduction: Stereotactic radiosurgery effectively controls vestibular schwannoma (VS). However, in certain cases, microsurgical resection may be necessary for tumor progression after radiosurgery or, after failure of the latter. The results on the safety and efficacy of salvage surgery for VS are still unclear, with scarce literature on the subject.

Objective: The present study aimed to evaluate the safety and efficacy of salvage surgery on the resection of vestibular schwannomas that have been previously treated with stereotactic radiosurgery or radiotherapy.

Methods: Following PRISMA guidelines, we searched Medline, Embase, and Web of Science databases. We used single proportion analysis with 95 % confidence intervals under a random-effects model, I² to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥ 4 patients treated with salvage surgery to resection of vestibular schwannomas after failure of stereotactic radiosurgery or radiotherapy.

Results: Of the 1841 initially identified studies, 18 were selected, involving 455 patients, with a median follow-up of 33 months. The combined analysis showed a 69 % (CI: 58 % - 79 %) rate of good clinical outcomes. Regarding partial resection, the pooled analysis confirmed a 48 % rate (CI: 33 % to 63 %) and a 52 % complete resection rate (CI: 37 % to 67 %). The pooled analysis confirmed a 95 % hearing preservation rate in patients undergoing the retrosigmoid approach (CI: 90 % to 100 %) and a 78 % facial nerve preservation rate (CI: 72 % to 84 %). Regarding complications, the pooled analysis confirmed a 20 % complication rate (CI: 14 % to 28 %). There were no deaths related to the procedure.

Conclusion: Based on the results, our meta-analysis identified that rescue surgery has been shown to be safe and effective for resection of vestibular schwannomas after failure of stereotactic radiosurgery or radiotherapy, based on good facial nerve preservation rate and total lesion resection rate.

Keywords: Radiotherapy; Salvage Surgery; Stereotactic Radiosurgery; Vestibular Schwannomas.