手术和放射外科是前庭神经鞘瘤最常见的治疗选择。进行了系统评价和荟萃分析,以比较手术与立体定向放射外科(SRS)的结果。
Cochrane图书馆,PubMed,Embase,和clinicaltrials.gov在2021年1月1日进行搜索,以找到所有关于前庭神经鞘瘤的手术和立体定向手术的研究。使用随机效应模型,汇总优势比(OR)和他们的95%置信区间(CI)比较后干预前的研究得出,对病例系列和干预后不良事件的汇总发生率进行了计算,并按干预类型进行了分层.
21项研究(18项前后设计;3个病例系列)987名患者纳入最终分析。比较干预后和干预前,手术(OR:3.52,95CI2.13,5.81)和SRS(OR:3.30,95CI1.39,7.80)均导致听力损失的可能性更大,头晕的几率较低(手术OR:0.10;95CI0.02,0.47vs.SRSOR:0.22;95CI0.05,0.99),和耳鸣(手术OR:0.23;95CI0.00,37.9;两项研究与SRSOR:0.11;95CI0.01,1.07;一项研究)。手术后面部对称性丧失的合并发生率更大(14.3%,95CI6.8%,22.7%)比SRS后(7%,95CI1%,36%)。手术中肿瘤控制更大(94%,95CI83%,98%)比SRS组(80%,95CI31%,97%)用于小到中等大小的肿瘤。
在前庭神经鞘瘤患者中,手术和SRS导致听力损失的几率相似,头晕和耳鸣的改善也相似;然而,面部对称性损失出现较高的术后。
Surgery and radiosurgery represent the most common treatment options for vestibular schwannoma. A systematic
review and meta-analysis were conducted to compare the outcomes of surgery versus stereotactic radiosurgery (SRS).
The Cochrane library, PubMed, Embase, and clinicaltrials.gov were searched through 01/2021 to find all studies on surgical and stereotactic procedures performed to treat vestibular schwannoma. Using a random-effects model, pooled odds ratios (OR) and their 95% confidence intervals (CI) comparing post- to pre-intervention were derived for pre-post studies, and pooled incidence of adverse events post-intervention were calculated for case series and stratified by intervention type.
Twenty-one studies (18 pre-post design; three case series) with 987 patients were included in the final analysis. Comparing post- to pre-intervention, both surgery (OR: 3.52, 95%CI 2.13, 5.81) and SRS (OR: 3.30, 95%CI 1.39, 7.80) resulted in greater odds of hearing loss, lower odds of dizziness (surgery OR: 0.10; 95%CI 0.02, 0.47 vs. SRS OR: 0.22; 95%CI 0.05, 0.99), and tinnitus (surgery OR: 0.23; 95%CI 0.00, 37.9; two studies vs. SRS OR: 0.11; 95%CI 0.01, 1.07; one study). Pooled incidence of facial symmetry loss was larger post-surgery (14.3%, 95%CI 6.8%, 22.7%) than post-SRS (7%, 95%CI 1%, 36%). Tumor control was larger in the surgery (94%, 95%CI 83%, 98%) than the SRS group (80%, 95%CI 31%, 97%) for small-to-medium size tumors.
Both surgery and SRS resulted in similar odds of hearing loss and similar improvements in dizziness and tinnitus among patients with vestibular schwannoma; however, facial symmetry loss appeared higher post-surgery.