Abstract：
Vestibular schwannomas (VS) are benign intracranial tumors posing significant management challenges. This study aims to compare the outcomes of stereotactic radiosurgery (SRS) and watchful waiting (WW) in the management of newly diagnosed VS, integrating findings from both retrospective and the pioneering V-REX prospective trial. Adhering to PRISMA guidelines, a systematic review was conducted using MEDLINE, Embase, and Cochrane databases. Studies directly comparing SRS with WW for newly diagnosed VS were included. Primary outcomes focused on hearing preservation assessed through the AAO-HNS or Gardner-Robertson hearing classification scales and tumor progression, with secondary outcomes focusing on neurological symptoms, and the need for further treatment. Thirteen studies encompassing 1,635 patients (WW: 891; SRS: 744) were included.While no significant difference was found in serviceable hearing loss at last follow-up (RR = 1.51, [95%CI: 0.98, 2.32], p = 0.06), significant differences favoring WW were observed in pure tone audiometry (PTA) (MD = -13.51 [95%CI: -22.66, -4.37], p = 0.004) and word recognition score (WRS) (MD = 20.48 [95%CI: 9.72, 31.25], p = 0.0002). Analysis of tumor progression indicated no overall significant difference in risk between SRS and WW (RR = 0.40, [95%CI 0.07, 2.40], p = 0.32), but subgroup analysis suggested a lower risk with SRS in certain contexts. The need for further treatments favored SRS (RR = 0.24, [95%CI: 0.07, 0.74], p = 0.007). No significant differences were found in tinnitus and imbalance between the two groups. This comprehensive analysis suggests no marked difference in functional hearing preservation between SRS and WW in managing VS. However, untreated tumors commonly necessitate additional interventions. These findings highlight the need for individualized treatment decisions and underscore the importance of continued monitoring. The study advocates for further prospective trials to refine management strategies for VS.
摘要：
前庭神经鞘瘤（VS）是良性颅内肿瘤，对治疗提出了重大挑战。本研究旨在比较立体定向放射外科（SRS）和观察等待（WW）在新诊断VS的治疗中的结果。整合回顾性和开创性的V-REX前瞻性试验的结果。坚持PRISMA准则，使用MEDLINE进行了系统审查，Embase,和Cochrane数据库。包括直接比较新诊断VS的SRS与WW的研究。主要结果集中在通过AAO-HNS或Gardner-Robertson听力分类量表评估的听力保护和肿瘤进展。次要结果集中在神经系统症状上，以及进一步治疗的需要。纳入13项研究，包括1,635例患者（WW：891；SRS：744）。虽然在最后一次随访时，有效听力损失没有发现显着差异（RR=1.51，[95CI：0.98，2.32]，p=0.06),在纯音测听（PTA）中观察到有利于WW的显着差异（MD=-13.51[95CI：-22.66，-4.37]，p=0.004）和单词识别得分（WRS）（MD=20.48[95CI：9.72，31.25]，p=0.0002)。肿瘤进展分析表明，SRS和WW之间的风险没有总体显着差异（RR=0.40，[95CI0.07,2.40]，p=0.32)，但是亚组分析提示在某些情况下SRS的风险较低.对进一步治疗的需求有利于SRS(RR=0.24，[95CI：0.07，0.74]，p=0.007)。两组在耳鸣和失衡方面没有发现显着差异。这项综合分析表明，SRS和WW在管理VS方面在功能听力保护方面没有显着差异。然而,未经治疗的肿瘤通常需要额外的干预措施。这些发现强调了个性化治疗决策的必要性，并强调了持续监测的重要性。该研究提倡进一步的前瞻性试验，以完善VS的管理策略。
