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J Neurol Surg B Skull Base 2015; 76(02): 157-162
DOI: 10.1055/s-0034-1383858
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Facial Nerve Outcome after Vestibular Schwannoma Resection: A Comparative Meta-Analysis of Endoscopic versus Open Retrosigmoid Approach

Abdullah Alobaid
1   Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
,
Mohammed Aref
1   Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
,
Michael Ross Bennardo
1   Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
,
Forough Farrokhyar
2   Department of Surgery, McMaster University, Hamilton, Ontario, Canada
,
Kesava Reddy
1   Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

05 April 2014

06 May 2014

Publication Date:
26 November 2014 (online)

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Abstract

The minimal access retrosigmoid endoscopic approach to vestibular schwannoma (VS) resection has been used with promising results. However, it has not been compared with the standard open approach in the literature. We performed a meta-analysis review for all articles describing both approaches for VS from 1996 to 2011. We found 1861 articles. After review and discussion, we narrowed our study to 25 articles, 4 endoscopic and 21 open. The total number of patients was 3026 for open and 790 for endoscopic. The mean tumor sizes in the open and endoscopic series were 2.5 cm and 2.7 cm, respectively. Good facial nerve outcome was achieved in 67% of the open series patients and in 94% of the endoscopic series patients. Other outcomes in the open and endoscopic series were the following: gross total resection, 91% versus 97%; functional hearing, 22.6% versus 46%; wound infection, 1.3% versus 2.6%; and recurrence, 5.4% versus 2.2%. We acknowledge the limitations of our study, but we can state that the endoscopic approach is not inferior to the standard open approach. In expert hands the endoscopic approach can offer as good a result as the open, with potential benefits such as less pain and a shorter length of stay in the hospital. There is a need for more controlled studies for a definitive comparison.

Keywords

vestibular schwannoma - endoscopic surgery - retrosigmoid approach - facial nerve
 

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