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

in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery by Frederico L Gibbon, Rafaela J Lindner, Antônio D M Vial, Guilherme G da Silva, Lucca B Palavani, Gabriel Semione, Paulo V Worm, Gustavo R Isolan, Vagner A R da Silva, Ricardo F Bento, Rick A Friedman, Joel Lavinsky

TLDR

  • The study compared two different ways to treat a type of brain tumor called vestibular schwannoma. The two ways were called the translabyrinthine approach (TLA) and the retrosigmoid approach (RSA). The study looked at how well each approach worked in terms of preventing complications like CSF leak, facial nerve dysfunction, and meningitis. The study found that there were no significant differences in these complications between the two approaches. However, the TLA was associated with a shorter length of stay in the hospital and a better outcome for the facial nerve compared to the RSA.

Abstract

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.

Overview

  • The study aims to compare the translabyrinthine approach (TLA) with the retrosigmoid approach (RSA) for vestibular schwannoma (VS) in terms of postoperative complications. The primary outcome was cerebrospinal fluid (CSF) leak; secondary outcomes were facial nerve dysfunction (FND), length of stay (LOS), and meningitis. The study used a systematic review and meta-analysis methodology, including PubMed, Web of Science, Embase, and Cochrane databases. The authors assessed risk of bias using ROBINS-I and performed sensitivity analysis with subgroup analysis and meta-regression. The study included 21 articles and 4572 patients, with 2687 and 1885 patients in the TLA and RSA groups, respectively. The study found no significant differences in CSF leak or meningitis between the groups. However, the TLA was associated with a shorter LOS and a higher chance of a better facial nerve outcome compared to the RSA.

Comparative Analysis & Findings

  • The study found no significant differences in CSF leak or meningitis between the TLA and RSA groups. However, the TLA was associated with a shorter LOS and a higher chance of a better facial nerve outcome compared to the RSA.

Implications and Future Directions

  • The study highlights the importance of considering the LOS and facial nerve outcome when choosing between the TLA and RSA for VS. Future studies should focus on comparing the long-term outcomes of the two approaches and assessing the impact of patient-specific factors on the choice of approach.
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