Comparison of surgical outcomes in cystic and solid vestibular schwannomas: a systematic review and meta-analysis

Most studies reported that cystic vestibular schwannoma (CVS) surgery has a less favourable prognosis than solid vestibular schwannoma (SVS) surgery. However, some studies report that it is unclear whether surgical outcomes for these conditions exhibit significant differences. The aim of this meta-analysis was to pool the current literature and describe and analyse any differences in the clinical symptoms and surgical outcomes among CVS and SVS. PubMed, Embase, and Cochrane databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through April 22, 2020. Outcomes were analysed using a meta-analysis of the proportions. The results of the search yielded 17 studies that met the criteria for inclusion and analysis, involving 3074 participants (including 821 patients with CVSs and 2253 patients with SVSs). No significant differences in the extent of tumour resection (gross-total resection versus non-gross-total resection; RR, 0.93; 95% CI, 0.86-1.01;p = 0.096) and most other outcomes were noted between CVS and SVS cohorts. However, facial nerve function (House-Brackmann Grade I or II versus III or more) of CVS patients was worse (RR, 0.86; 95% CI, 0.78-0.93;p < 0.001) compared with SVS patients with more than 1 year of follow-up after surgery. The criteria of cystic acoustic neuroma needs to be further unified, and prospective cohort studies with larger sample sizes should be performed for further verification of these results in the future.

Automated summary

Most studies indicate that cystic vestibular schwannoma surgery tends to have a less favorable prognosis compared to solid vestibular schwannoma surgery, although there are no significant differences in tumor resection extent and most other outcomes between the two conditions. However, facial nerve function of cystic vestibular schwannoma patients appears worse than that of solid vestibular schwannoma patients in long-term follow-up after surgery. Further standardization of the diagnostic criteria for cystic acoustic neuroma is necessary, with prospective cohort studies with larger sample sizes needed for future verification of these results.