SynthesisJournal of neuro-oncology2025
Large vestibular schwannoma treated using a cranial nerve sparing approach with planned subtotal microsurgical resection and stereotactic radiosurgery: meta-analysis and International Stereotactic Radiosurgery Society (ISRS) practice guidelines.
Synthesis in Journal of neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Vestibular schwannoma with hemorrhage in a 63-year-old female: A case report.Radiology case reports · 2026Article
- Hybrid frame-mask fixation for Gamma Knife radiosurgery of an extracranial vagal schwannoma: illustrative case.Journal of neurosurgery. Case lessons · 2026Article
- Clinical management of vestibular schwannoma - what's the evidence?Acta neurochirurgica · 2026Review
- Vestibular schwannoma microsurgery in the era of multimodal treatment: advances in technique and patient selection.Journal of neuro-oncology · 2026Review
- A Single-center experience of subperineural resection of intracranial schwannomas and the clinical course following subtotal resection.Frontiers in oncology · 2026Article
- Combined subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: A systematic review and meta-analysis.Neuro-oncology advancesReview
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11 authors.
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Abstract
introductionStereotactic radiosurgery (SRS) has become a standard of care for small- to medium- size vestibular schwannomas (VS), while the majority of patients with large VS still require microsurgical resection due to potential consequences of long tract and cranial nerve compression, intracranial hypertension or hydrocephalus.
methodsWe performed a systematic review and meta-analysis of the literature specific to planned subtotal resection for large VSs followed by SRS to the residual tumor to inform clinical practice guideline development. The Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach to search for manuscripts reporting outcomes for large VSs treated with this paradigm, with a search end date of June 1st 2023. Crude outcomes were pooled using weighted random effects.
results12 series met inclusion criteria reporting on treatment outcomes for 677 patients. Overall tumor control was 89.9% (86.9-92.9%, p < 0.001), with tumor stability observed in 43.9% (19.9-68%, p < 0.001) and tumor reduction in 39.9% (57-74.2%, p = 0.02) post-SRS. Facial nerve functional preservation immediately after microsurgery was 88.0% (82.7-93.3%, p < 0.001), improving to 94.4% (91.4-97.4%, p < 0.001) at last follow-up. Cochlear functional preservation immediately after microsurgery was 58.8% (33.2-84.4%, p < 0.001), decreasing to 57.4% (33-81.8%, p < 0.001) at last follow-up.
conclusionsA cranial nerve sparing approach with planned subtotal microsurgical resection and SRS to the residual tumor achieves high rates of tumor control with highly satisfactory outcome of facial and cochlear functional preservation. Clinical practice consensus recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS) are also presented.
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