Stereotactic Radiosurgery in Primary Treatment of Sporadic Small to Medium (<3 cm) Vestibular Schwannomas: A Systematic Review and Meta-Analysis

OBJECTIVE: To analyze the literature regarding the use of stereotactic radiosurgery as the primary treatment of vestibular schwannoma to further evaluate efficacy and treatment-related neurologic deficits. METHODS: Online databases were queried to identify relevant studies from January 2001 to December 2020. Full-text articles in English for sporadic vestibular schwannoma treated primarily with radiosurgery and documented hearing preservation data were reviewed. Studies that had a minimum follow-up period of less than 36 months, did not use radiosurgery for primary treatment, or included patients with neurofibromatosis type 2 were excluded. RESULTS: A total of 33 studies involving 4286 patients with an average follow-up of 62.5 months were included in the final analysis. All 33 studies included eligible hearing data; overall preservation of serviceable hearing was found to be 58.27%. Twenty-seven studies with 3822 eligible patients were analyzed for tumor control rates; overall, tumor control was reported in 92.98% of cases. Twenty-seven studies were analyzed for posttreatment facial nerve dysfunction, which was reported in 1.53% of cases. CONCLUSIONS: Stereotactic radiosurgery is a safe and effective primary treatment modality for sporadic vestibular schwannoma as shown by the present analysis. Radiosurgery is effective regarding tumor control and hearing preservation and offers a low rate of posttreatment facial nerve dysfunction.