Facial Nerve and Hearing Preservation after Surgery to Resection Vestibular Schwannomas after Stereotactic Radiosurgery Failure with Gamma Knife: A Systematic Review and Meta-Analysis

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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 of salvage surgery for VS are still unclear, with scarce literature on the subject. Objective: The present study aimed to evaluate the facial nerve and hearing preservation of surgery on the resection of vestibular schwannomas that have been previously treated with Gamma Knife. Materials and 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, I 2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥3 patients treated with salvage surgery to resection of vestibular schwannomas after failure of stereotactic radiosurgery with Gamma Knife. Results: Of the 1,841 initially identified studies, 19 were selected, involving 466 patients, with a median follow-up of 33 months. The combined analysis showed a 98% rate (CI: 95–100%) rate of hearing preservation. Regarding facial nerve preservation, the pooled analysis confirmed a 84% rate (CI: 78–90%). Conclusion: Based on the results, our meta-analysis identified that rescue surgery has been shown to be safe for resection of vestibular schwannomas after failure of stereotactic radiosurgery with Gamma Knife, based on facial nerve and hearing preservation rate. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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