The effect of a learning curve on outcomes of vestibular schwannoma surgery: A systematic review.

Abstract

Vestibular schwannoma (VS) surgery can be complex, with the risk of incurring significant neurological deficit or other complication. Our systematic review aimed to investigate the presence of a 'learning curve' for various outcomes in VS surgery. The review was conducted in accordance with PRISMA guidelines, with the Medline, Scopus, Embase, Cochrane library and Web of Science databases searched on the 30/4/25 for articles investigating the learning curve in VS surgery. Information extracted included age, gender, surgical approach, surgery duration, extent of resection, facial nerve (FN) outcome, hearing preservation (HP), complications, and further treatment. The time or patient number intervals that the learning curve was assessed at was recorded as well. The Newcastle-Ottawa Scale was utilised to determine risk of bias. Twelve studies were identified, reporting on 4059 VS cases. FN function was reported in eleven studies, all of which suggested improved FN outcomes with increased surgical experience. Hearing preservation was demonstrated to be statistically significant in four studies. Studies sporadically reported on surgical duration, resection and complication rates, with no clear learning curve identified for any of these outcomes. Our review identified the presence of a learning curve with regards to FN outcome in VS surgery with a plateau in initial surgical learning curve being obtained in the later cases of an early career sergeon's experience. A learning curve was also found for HP in cases where this was an operative goal. Evidence demonstrating a learning curve for other outcomes is limited.Copyright © The Author(s) 2026.