Large vestibular schwannoma treated using a cranial nerve sparing approach with planned subtotal microsurgical resection and stereotactic radiosurgery: meta-analysis and International Stereotactic Radiosurgery Society (ISRS) practice guidelines
Bibliographic record
Abstract
INTRODUCTION: Stereotactic radiosurgery (SRS) has become a standard of care for small- to medium- size vestibular schwannomas (VS), while the majority of patients with large VS still require microsurgical resection due to potential consequences of long tract and cranial nerve compression, intracranial hypertension or hydrocephalus. METHODS: We performed a systematic review and meta-analysis of the literature specific to planned subtotal resection for large VSs followed by SRS to the residual tumor to inform clinical practice guideline development. The Medline and Embase databases were used to apply the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach to search for manuscripts reporting outcomes for large VSs treated with this paradigm, with a search end date of June 1st 2023. Crude outcomes were pooled using weighted random effects. RESULTS: 12 series met inclusion criteria reporting on treatment outcomes for 677 patients. Overall tumor control was 89.9% (86.9-92.9%, p < 0.001), with tumor stability observed in 43.9% (19.9-68%, p < 0.001) and tumor reduction in 39.9% (57-74.2%, p = 0.02) post-SRS. Facial nerve functional preservation immediately after microsurgery was 88.0% (82.7-93.3%, p < 0.001), improving to 94.4% (91.4-97.4%, p < 0.001) at last follow-up. Cochlear functional preservation immediately after microsurgery was 58.8% (33.2-84.4%, p < 0.001), decreasing to 57.4% (33-81.8%, p < 0.001) at last follow-up. CONCLUSIONS: A cranial nerve sparing approach with planned subtotal microsurgical resection and SRS to the residual tumor achieves high rates of tumor control with highly satisfactory outcome of facial and cochlear functional preservation. Clinical practice consensus recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS) are also presented.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.029 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.042 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".