Translabyrinthine versus Retrosigmoid Approach for Vestibular Schwannoma: A Systematic Review and An Updated Meta-Analysis

Several approaches can be used in the surgical treatment of vestibular schwannoma (VS), and the best approach remains uncertain in the literature. This systematic review and meta-analysis aim to compare the translabyrinthine approach (TLA) with the retrosigmoid approach (RSA) for VS in terms of post...

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Bibliographic Details
Published in:	Otolaryngology-head and neck surgery
Main Authors:	Gibbon, Frederico L, Lindner, Rafaela J, Vial, Antônio D M, da Silva, Guilherme G, Palavani, Lucca B, Semione, Gabriel, Worm, Paulo V, Isolan, Gustavo R, da Silva, Vagner A R, Bento, Ricardo F, Friedman, Rick A, Lavinsky, Joel
Format:	Journal Article
Language:	English
Published:	England 22-10-2024
Subjects:	cerebrospinal fluid leak length of stay translabyrinthine approach retrosigmoid approach facial nerve dysfunction vestibular schwannoma
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Summary:	Several approaches can be used in the surgical treatment of vestibular schwannoma (VS), and the best approach remains uncertain in the literature. This systematic review and meta-analysis aim to compare the translabyrinthine approach (TLA) with the retrosigmoid approach (RSA) for VS in terms of postoperative complications. PubMed, Web of Science, Embase, and Cochrane. The primary outcome was cerebrospinal fluid (CSF) leak; secondary outcomes were facial nerve dysfunction (FND), length of stay (LOS), and meningitis. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed with I² statistics. We performed sensitivity analysis with subgroup analysis and meta-regression. Risk of bias was assessed using ROBINS-I. Out of 1140 potential articles, 21 met the inclusion criteria. Among the 4572 patients, 2687 and 1885 patients in the TLA and RSA groups, respectively. No significant differences were found in CSF leak (odds ratio [OR] 1.03; 95% confidence interval [CI] 0.81,1.32; P = .794) or meningitis (OR 1.05; 95% CI 0.45, 2.43; P = .73). Meta-regression showed no association with CSF leak and the number of cases per center or publication year. The TLA is associated with a shorter LOS (MD -1.20; 95% CI -1.39, -1.01; P < .01) and a higher chance of having and HB 4 or lower compared to patients who underwent RSA (OR 0.30; 95% CI 0.10, 0.89; P = .03). There was no difference in the odds of CSF leak or meningitis between the groups. In addition, the TLA has a shorter LOS and a higher chance of a better facial nerve outcome compared to the RSA.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	0194-5998 1097-6817 1097-6817
DOI:	10.1002/ohn.1031