Translabyrinthine versus middle fossa approaches for vestibular schwannoma surgery: a systematic review and comparative meta-analysis.

INTRODUCTION

Vestibular schwannomas (VS) are tumors in which surgery via translabyrinthine (TL) or middle cranial fossa (MCF) is standard, but the optimal approach remains debated. This meta-analysis evaluated TL and MCF approaches for VS management, emphasizing reoperation rate and complications.

METHODS

PubMed, Embase, Web of Science, and Cochrane Library search. I² statistics were used to assess heterogeneity. Odds Ratios (OR) were used for binary event analyses, with Baujat and leave-one-out analyses applied to identify heterogeneity sources.

RESULTS

The analysis of patients returning to the operating room included 230 patients in the MCF group and 592 in the TL group, demonstrating a lower reoperation rate with the MCF approach (OR 0.41, 95% CI 0.18-0.91, I2 = 0%). For complications, 9 studies involving 448 patients in the MCF group and 990 in the TL group showed similarity (OR 0.92, 95% CI 0.50-1.68, I2 = 54%). Cerebrospinal fluid leaks were analyzed in 3,323 (833 in MCF, 2,490 in TL), showing no statistical difference (OR 0.75, 95% CI 0.49-1.13, I² = 21%). Facial nerve preservation, assessed in 3 studies involving 516 patients in the MCF group and 614 in the TL group, revealed similarity (OR 1.43, 95% CI 0.48-4.27, I2 = 88%). Wound infection rate was analyzed in 2,310 patients (657 in MCF, 1653 in TL), being comparable (OR 0.91, 95% CI 0.31-2.69, I2 = 34%).

CONCLUSION

Both approaches demonstrated comparable outcomes, suggesting that individual patient characteristics and surgeon expertise can guide the choice of treatment. However, the MCF approach may be associated with fewer reoperations.