Combined Subtotal Resection and Stereotactic Radiosurgery for Large Vestibular Schwannomas: A Systematic Review and Meta-Analysis Publisher



Naghizadeh S ; Zohrabifard M ; Keramati AA ; Jafari F ; Oraii Yazdani K ; Zali A ; Oraeeyazdani S
Source: Neuro-Oncology Advances Published:2025

Abstract

Background Large vestibular schwannomas (VSs), particularly Koos grade III-IV, often require a balance between tumor control and cranial nerve preservation. This meta-analysis evaluates outcomes of planned subtotal or near-total resection (STR/NTR) followed by stereotactic radiosurgery (SRS) and explores prognostic factors. Methods Following PRISMA guidelines, a systematic review was conducted across four databases for studies published from January 2017 to January 2025, reporting outcomes of STR/NTR followed by SRS in large VSs. Pooled proportions for tumor control, facial nerve preservation (House–Brackmann grade I-II), and hearing preservation (Gardner–Robertson class I-II) were calculated using random-effects models. Heterogeneity, publication bias, and risk of bias were assessed. Meta-regression evaluated the impact of preoperative cranial nerve function and tumor characteristics. Results Fourteen studies encompassing 934 patients were included. The pooled tumor control rate was 80%, with facial nerve function preserved in 85% and serviceable hearing in 43%. Meta-regression indicated that better preoperative HB and GR scores were significantly associated with superior outcomes (P<.05), while cystic tumor morphology correlated with reduced tumor control following SRS (P<.05). Compared to prior meta-analyses of gross-total resection (GTR), the combined STR/NTR plus SRS approach demonstrated superior nerve preservation and functional outcomes. Conclusions STR/NTR followed by SRS is an effective treatment for large VSs, optimizing tumor control while enhancing facial nerve and hearing preservation compared to GTR alone. Patients with favorable preoperative function benefit most. Cystic tumors may require closer follow-up due to increased recurrence risk. © The Author(s) 2025. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology.