Neurosurgery 97:545–558, 2025
Meta-analysis of 949 trigeminal schwannoma patients found stereotactic radiosurgery (SRS) led to greater improvement in facial hypesthesia and motor deficits, but surgery was superior for facial pain relief. Both approaches provided similar tumor control. Treatment should be individualized based on patient characteristics, tumor profile, and symptoms.
• Trigeminal schwannomas (TS) are rare, benign nerve sheath tumors, with no clear consensus on optimal treatment between surgical resection and stereotactic radiosurgery (SRS).
• Meta-analysis included 29 retrospective studies with 949 patients: 589 had SRS, 360 had surgery; larger tumors were more likely to be treated surgically.
• SRS led to significantly higher rates of facial hypesthesia (numbness) improvement (44% vs 12%) and lower rates of new hypesthesia (4% vs 15%) compared to surgery.
• Surgery was more effective for improving facial pain (81% vs 58% after SRS).
• Both SRS and surgery provided high and similar tumor control rates (89% SRS vs 91% surgery).
• Trigeminal motor function improved more after SRS, but data were limited.
• Treatment choice should be individualized, considering tumor size, patient characteristics, and presenting symptoms.
• Limitations include retrospective design, heterogeneous data, and lack of standardization for outcome measures.
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