Salvage surgery following primary treatment in recurrent vestibular schwannoma: surgical outcomes and progression-free survival- a meta-analysis.

BACKGROUND

Vestibular schwannomas (VS) are benign tumors of the eighth cranial nerve. While gross total resection (GTR) is often achieved in primary surgery, recurrence remains a therapeutic challenge. Repeat microsurgery is a key treatment option, but evidence is limited and inconsistently reported. This study systematically synthesizes current data on outcomes after repeat microsurgical resection for recurrent VS.

METHODS

A systematic PubMed search identified studies reporting outcomes of repeat microsurgery for recurrent VS. Extracted data included patient characteristics, GTR rate, progression-free survival (PFS), facial nerve function (House-Brackmann scale), hearing preservation, postoperative complications, and hydrocephalus or shunt dependency. Pooled analyses using random-effects models estimated summary proportions across studies.

RESULTS

Ten studies including 359 patients met inclusion criteria. The pooled GTR rate was 0.71 (95% CI: 0.46-0.87). Four studies (49 patients) reported PFS, with no tumor recurrences (pooled proportion = 1.00). Postoperative facial nerve deterioration occurred in 43% (95% CI: 0.29-0.58). Cerebrospinal fluid (CSF) leakage was the most frequent complication (11% (95% CI: 0.05-0.21)). Between-study heterogeneity was low to moderate in most of the studies (I² = 0-38.6%).

CONCLUSIONS

Repeat microsurgery for recurrent VS provides good tumor control but carries higher risks of facial nerve deterioration and other complications compared with primary surgery. Current evidence is limited by small cohorts and retrospective designs. Standardized reporting and prospective multicenter studies are required to improve treatment strategies for this rare and challenging condition.