title: Facial Nerve Outcome after Vestibular Schwannoma Resection: A Comparative Meta-Analysis of Endoscopic versus Open Retrosigmoid Approach.
abstract: The minimal access retrosigmoid endoscopic approach to vestibular schwannoma (VS) resection has been used with promising results. However, it has not been compared with the standard open approach in the literature. We performed a meta-analysis review for all articles describing both approaches for VS from 1996 to 2011. We found 1861 articles. After review and discussion, we narrowed our study to 25 articles, 4 endoscopic and 21 open. The total number of patients was 3026 for open and 790 for endoscopic. The mean tumor sizes in the open and endoscopic series were 2.5 cm and 2.7 cm, respectively. Good facial nerve outcome was achieved in 67% of the open series patients and in 94% of the endoscopic series patients. Other outcomes in the open and endoscopic series were the following: gross total resection, 91% versus 97%; functional hearing, 22.6% versus 46%; wound infection, 1.3% versus 2.6%; and recurrence, 5.4% versus 2.2%. We acknowledge the limitations of our study, but we can state that the endoscopic approach is not inferior to the standard open approach. In expert hands the endoscopic approach can offer as good a result as the open, with potential benefits such as less pain and a shorter length of stay in the hospital. There is a need for more controlled studies for a definitive comparison.
authors.affiliation: Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alobaid
authors.affiliation: Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aref
authors.affiliation: Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Michael Ross
authors.initials: MR
authors.lastname: Bennardo
authors.affiliation: Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Forough
authors.initials: F
authors.lastname: Farrokhyar
authors.affiliation: Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kesava
authors.initials: K
authors.lastname: Reddy
keywords: endoscopic surgery; facial nerve; retrosigmoid approach; vestibular schwannoma
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