Equivalent Efficacy and Safety of Radiosurgery for Cystic and Solid Vestibular Schwannomas: A Systematic Review

Elie Massaad, Nima Hamidi, Jacalynn Goetz, Varun Padmanaban, Christine Mau, Derek Tsang, Fabio Y. de Moraes, Caroline Chung, Brad E. Zacharia, Alireza Mansouri

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Cystic vestibular schwannomas (VS) are associated with unpredictable growth behavior and potentially worse surgical outcomes compared with their solid counterparts. Growth control and potential adverse effects of radiosurgery for cystic VS have created concerns surrounding this modality. We sought to compare the treatment efficacy and safety profile of radiosurgery between cystic and solid VS through a systematic review. Methods: PubMed, EMBASE, Web of Science, and Cochrane were searched for related terms and studies reporting radiosurgical outcomes of cystic and solid VS. A meta-analysis was performed to compare the rates of tumor control. Random-effect models with generic inverse variance method was used to calculate overall pooled estimates. Study quality was assessed with the Newcastle Ottawa Criteria. Results: In total, 2989 studies were retrieved, and 6 including 1358 VS (79.89% solid; 20.11% cystic, median follow-up range 31.8–150 months) were selected. The median maximal dose was 25 Gy (range, 13–36 Gy) and the median marginal tumor dose was 12 Gy (10–18 Gy). There was no difference between cystic and solid VS (risk ratio, 1.02; 95% confidence interval 0.94–1.10; P = 0.69; I2 = 78%). Transient enlargement of cystic tumors may be associated with trigeminal or facial neuropathy. Conclusions: The evidence collected by this study suggests that radiosurgery for cystic VS exhibits effective tumor control probabilities similar to solid VS. Consensus definitions and standard criteria are needed in the future to better understand the patterns of tumor growth and response to treatment following radiosurgery for cystic VS, as well as long-term neurological and functional outcomes.

Original languageEnglish (US)
Pages (from-to)322-331.e1
JournalWorld neurosurgery
Volume146
DOIs
StatePublished - Feb 2021

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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