Comparative Analysis of Adverse Outcomes in Vestibular Schwannoma Treatment: Stereotactic Radiosurgery versus Surgery

Background: Vestibular schwannomas are benign tumors of the eighth cranial nerve, often causing hearing loss and dizziness. Treatment options include stereotactic radiosurgery (SRS) and surgery. This study compares the outcomes of these treatments at 30-days, 90-days, and 1-year post-treatment using a large national database.

Methods: A retrospective cohort study used data from the TriNetX platform, covering 86 healthcare organizations. Adults with vestibular schwannomas (ICD-10: D33.3) were included, excluding those with neurofibromatosis (ICD-10: Q85.00 and Q85.02) or otologic/audiologic implants (ICD-10: Z96.2). Patients were divided into SRS (CPT: 61798) and surgical resection cohorts (CPT: 61616, 6159x), matched 1:1 using propensity scores (n = 850 per group). Outcomes assessed included death, stroke, facial palsy, vestibular dysfunction, diplopia, trigeminal neuralgia, cerebrospinal fluid (CSF) leak, meningitis, and ataxia at 30-, 90-, and 365-days post-treatment. Notably, diplopia, CSF leak, and ataxia were absent in the SRS group at 30-days, with CSF leak also absent at 90-days. Significant odds ratios are detailed in [Fig. 1]; non-significant ratios are in [Table 1].

Fig. 1 Forest plot of odds ratios for select postsurgical or SRS adverse events measured at 30 days, 90 days, and 1 year.

Results: At 1 year, the SRS group had significantly lower risks of stroke, facial palsy, and CSF leak ([Table 1], [Fig. 1]). There were no significant differences in death, trigeminal neuralgia, or meningitis risks between groups. The absence of a difference in vestibular dysfunction suggests age-matched analysis may neutralize long-term imbalance concerns linked with radiation.

Conclusion: SRS treatment for vestibular schwannomas is associated with reduced risks of stroke, facial palsy, and CSF leaks at 1 year compared with surgical resection. Similar rates of vestibular dysfunction highlight important considerations for treatment decisions, especially regarding long-term quality of life.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025