Stereotactic Radiosurgery for Facial Nerve Schwannoma: A Systematic Review and Meta-Analysis.

Abstract

Facial nerve schwannomas (FNS) are rare intracranial lesions that pose a therapeutic challenge due to their proximity to critical neurovascular anatomical structures. While microsurgical resection (MS) is linked to a significant risk of facial nerve dysfunction, stereotactic radiosurgery (SRS) is a non-invasive alternative that may reduce the potential damage to the facial nerve. This systematic review and meta-analysis aimed to assess the efficacy and safety of SRS in patients with FNS. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science, following the PRISMA guideline. Studies that evaluate local control (LC), facial nerve function (FNF), hearing function (HF), and adverse radiation effect (ARE) for SRS in FNS were included. Ten studies comparing 166 FNS cases were included. The meta-analysis showed a pooled LC rate of 99% (95% CI: 95%-100%). It revealed a pooled improved or stable FNF rate of 76% (95% CI: 56%-92%) and HF rate of 92% (95% CI: 77%-100%). Additionally, the analysis exhibited a pooled ARE rate of 9% (95% CI: 5%-16%) following SRS in patients with FNS. SRS is an effective and safe option for managing patients with FNS, showing promising clinical and radiologic outcomes, especially in those with small-sized lesions or favorable FNF. Future studies should focus on directly comparing SRS and MS in large, prospective, multicenter trials.