2025 Proffered Presentations
S285: TRANSLABYRINTHINE VS. RETROSIGMOID APPROACH FOR VESTIBULAR SCHWANNOMA: A COMPARATIVE OUTCOMES STUDY WITH THE REAL-WORLD POPULATION-BASED DATA
Jinpyo Hong, BS1; David Hallan, MD2; Elias Rizk, MD, PhD2; 1Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center; 2Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center
Introduction: Vestibular schwannoma is a benign brain tumor often managed through various modalities depending on the size and symptoms. When surgical intervention is necessary, the most chosen surgical approaches are translabryinthine (hearing non-preserving) and retrosigmoid (hearing preserving) approaches depending on the patients’ ability to hear and the size and characteristics of the tumor. While these surgical approaches have been compared in the current literature, there is dearth of information when it comes to the population-level data that equips surgeons to provide an evidence-based explanation of the advantages and drawbacks of each approach when communicating these approaches to the patients. This study aims to analyze the risk of developing various outcomes following vestibular schwannoma resection surgeries using translabyrinthine or retrosigmoid approaches.
Methods: A retrospective data collection was carried out by querying TriNetX database, a database that houses multi-institutional patient data at the population level. Translabyrinthine cohort and retrosigmoid cohort were designed, and ten outcomes of interest were collected including ataxic/paralytic gait, tinnitus, headache, meningitis, facial weakness/paralysis, dizziness, stroke, injury of cranial nerve, injury of facial nerve only, and cerebrospinal fluid (CSF) leak. Only the outcomes that took place within 30 days after the index event (resection surgery) were considered. Propensity score matching was performed to balance the characteristics of the cohorts including demographic information and comorbidities, and the statistical risk analyses were performed.
Results: 1,165 patients were identified in both translabyrinthine and retrosigmoid cohorts After propensity score-matching, and the average age at index were 56.7 and 57.0 years old, respectively. Translabyrinthine cohort included 53.9% female patients and 77.3% white patients, while retrosigmoid cohort included 53.1% female patients and 78.6% white patients. Translabyrinthine cohort had a statistically significantly higher odds of developing both post-operative tinnitus (OR [95%CI], 1.571 [1.131-2.182]) and facial weakness/paralysis (1.24 [1.011-1.52]). Meanwhile, ataxic/paralytic gait, headache, meningitis, dizziness, stroke, and CSF leak did not show difference between the cohorts. Injury of cranial nerve and injury of facial nerve only were not analyzable due to the retrosigmoid cohort containing equal or less than 10 patients for those outcomes. The database is set to yield “10” for any number of patients that ranges from one to ten for privacy reasons. Table 1 summarizes the overall results.
Conclusion: The data suggest that there are increased risks of developing tinnitus and facial weakness/paralysis following translabyrinthine approach in comparison to the retrosigmoid approach. Interestingly, facial nerve damage was not comparable due to the low number of patients in the retrosigmoid cohort. These population-level significance could be further validated through an single-institutional study with patient-specific conditions.
Table 1. Comparative Risks of Developing Adverse Outcomes following Translabyrinthine and Retrosigmoid Approaches for Vestibular Schwannoma Resection Surgeries
Table 1 outlines the risks of developing ten post-operative adverse outcomes following vestibular schwannoma resection surgeries using translabyrinthine and retrosigmoid approaches.