{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T14:17:40Z","timestamp":1767017860984,"version":"3.48.0"},"reference-count":92,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,6]]},"abstract":"<jats:title>AbstractAbstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Large vestibular schwannomas (VSs), particularly Koos grade III-IV, often require a balance between tumor control and cranial nerve preservation. This meta-analysis evaluates outcomes of planned subtotal or near-total resection (STR\/NTR) followed by stereotactic radiosurgery (SRS) and explores prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, a systematic review was conducted across four databases for studies published from January 2017 to January 2025, reporting outcomes of STR\/NTR followed by SRS in large VSs. Pooled proportions for tumor control, facial nerve preservation (House\u2013Brackmann grade I-II), and hearing preservation (Gardner\u2013Robertson class I-II) were calculated using random-effects models. Heterogeneity, publication bias, and risk of bias were assessed. Meta-regression evaluated the impact of preoperative cranial nerve function and tumor characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen studies encompassing 934 patients were included. The pooled tumor control rate was 80%, with facial nerve function preserved in 85% and serviceable hearing in 43%. Meta-regression indicated that better preoperative HB and GR scores were significantly associated with superior outcomes (P\u2009&amp;lt;\u2009.05), while cystic tumor morphology correlated with reduced tumor control following SRS (P\u2009&amp;lt;\u2009.05). Compared to prior meta-analyses of gross-total resection (GTR), the combined STR\/NTR plus SRS approach demonstrated superior nerve preservation and functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>STR\/NTR followed by SRS is an effective treatment for large VSs, optimizing tumor control while enhancing facial nerve and hearing preservation compared to GTR alone. Patients with favorable preoperative function benefit most. Cystic tumors may require closer follow-up due to increased recurrence risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/noajnl\/vdaf199","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T11:56:49Z","timestamp":1761134209000},"source":"Crossref","is-referenced-by-count":0,"title":["Combined subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: A systematic review and meta-analysis"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6659-1825","authenticated-orcid":false,"given":"Shahin","family":"Naghizadeh","sequence":"first","affiliation":[{"name":"Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran,","place":["Iran"]},{"name":"Functional Neurosurgery Research Center, Research Institute of Functional Neurosurgery, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences , Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4089-6708","authenticated-orcid":false,"given":"Maryam","family":"Zohrabi-Fard","sequence":"additional","affiliation":[{"name":"Functional Neurosurgery Research Center, Research Institute of Functional Neurosurgery, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences , Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3460-6815","authenticated-orcid":false,"given":"Amir-Ahmad","family":"Keramati","sequence":"additional","affiliation":[{"name":"Functional Neurosurgery Research Center, Research Institute of Functional Neurosurgery, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences , Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9862-6524","authenticated-orcid":false,"given":"Fatemeh","family":"Jafari","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences , Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaveh","family":"Oraii Yazdani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Zahedan University of Medical Sciences , Zahedan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2298-2290","authenticated-orcid":false,"given":"Alireza","family":"Zali","sequence":"additional","affiliation":[{"name":"Functional Neurosurgery Research Center, Research Institute of Functional Neurosurgery, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences , Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4550-9698","authenticated-orcid":false,"given":"Saeed","family":"Oraee-Yazdani","sequence":"additional","affiliation":[{"name":"Functional Neurosurgery Research Center, Research Institute of Functional Neurosurgery, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences , Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"2025122909121589800_vdaf199-B1","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2017.12.FOCUS17669","article-title":"Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a \u201cnerve-centered\u201d approach","volume":"44","author":"Starnoni","year":"2018","journal-title":"Neurosurg 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