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, I = 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, I = 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, I = 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, I = 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.