Microsurgery Versus Radiosurgery for Vestibular Schwannoma: Which Approach Yields Better Long-Term Results?

Vestibular schwannoma (VS) is a common benign intracranial tumor that can significantly affect quality of life (QoL), particularly through hearing loss and balance impairment. Microsurgery and radiosurgery are established treatment options, but there is ongoing debate over which provides better long-term outcomes, especially for tumors smaller than 3 cm. This systematic review aims to compare the long-term outcomes of microsurgery versus radiosurgery for the management of VS ≤ 2.5 cm. We conducted a systematic review of cohort studies involving patients aged 18 years or older with VS measuring ≤ 2.5 cm, comparing outcomes of microsurgery and radiosurgery. Relevant databases were searched, and studies were selected and assessed for methodological quality. Tumor control, hearing preservation, and improvement in vestibular symptoms were examined. A thorough database search identified 547 articles, of which 4 met the inclusion criteria and were selected for analysis, encompassing a total of 1,167 participants. Microsurgery showed superior tumor control and greater improvement in vestibular symptoms, whereas radiosurgery was associated with higher rates of hearing preservation. However, findings varied across studies, and the absence of randomized controlled trials limits the strength of current evidence. Both microsurgery and radiosurgery offer benefits depending on the patient's clinical priorities. Treatment decisions should be individualized. Further prospective, reliable studies are needed to determine the optimal management strategy based on long-term functional outcomes and QoL.