Objective: Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic review and meta-analysis were conducted to compare the outcomes of surgery versus stereotactic radiosurgery (SRS).

Methods: The Cochrane library, PubMed, Embase, and clinicaltrials.gov were searched through 10/2020 to find all studies on surgical and stereotactic procedures performed to treat vestibular schwannoma. Using a random-effects model, pooled odds ratios (OR) and their 95% confidence intervals (CI) comparing post- to pre-intervention were derived for pre-post studies. Pooled incidence of adverse events post-intervention were calculated for case series. Results were stratified by intervention type.

Results: Twenty-one studies (18 pre-post design; three case series) with 987 patients were included in the final analysis. Comparing post- to pre-intervention, both surgery (OR: 3.52, 95%CI 2.13, 5.82; 19 studies) and SRS (OR: 3.30, 95%CI 1.40, 7.80; nine studies) resulted in greater odds of hearing loss. Pooled incidence of facial symmetry loss was larger post-surgery (14.3%, 95%CI 6.8%, 22.7%) than post-SRS (7%, 95%CI 1%, 36%). Both surgery and SRS resulted in lower odds of dizziness (surgery OR: 0.10; 95%CI 0.02, 0.48; two studies vs. SRS OR: 0.38; 95%CI 0.05, 2.83; one study) and tinnitus (surgery OR: 0.23; 95%CI 0.00, 37.9; two studies vs. SRS OR: 0.11; 95%CI 0.01, 1.07; one study).

Conclusion: Both surgery and SRS resulted in larger odds of hearing loss and similar improvements in dizziness and tinnitus among patients with vestibular schwannoma; however, facial symmetry loss appeared higher post-surgery. Well-designed comparative studies are needed to better compare each management strategy and optimally guide patients in treatment selection.