背景:选择适当的治疗前庭神经鞘瘤(ICVS)的策略仍存在争议。我们进行了系统评价和荟萃分析,目的是比较管理策略(保守监测(CS),显微手术切除(MR),或立体定向放射外科(SRS))旨在代表国际立体定向放射外科学会(ISRS)提供指南建议。
方法:使用PRISMA指南,我们审查了1990年1月至2021年10月发表的在PubMed®或Embase®中引用的手稿。纳入标准为同行评审的临床研究或病例系列,报告使用CS管理的ICVS队列,MR或SRS。主要结果指标包括肿瘤控制,需要额外的治疗,听力结果,和治疗后的神经功能缺损。使用荟萃分析技术汇总这些数据,并使用具有随机效应的荟萃回归进行比较。
结果:纳入40项研究(2371例患者)。在SRS和CS系列中,肿瘤控制的加权汇总估计分别为96%和65%,分别(p<0.001)。需要进一步治疗的报告为1%,2%和25%的SRS,MR,CS,分别(p=0.001)。据报道,67%的人保留听力,68%,和55%的SRS,MR,CS,分别(p=0.21)。SRS和MR系列持续面神经缺损分别为0.1%和10%。分别(p=0.01)。
结论:SRS是一种非侵入性治疗,与MR相比,肿瘤控制率和听力保留率至少相等,具有更好的面部神经保护的警告。与CS相比,前期SRS是实现肿瘤控制的有效治疗方法,听力保留率相似。
The choice of an appropriate strategy for intracanalicular vestibular schwannoma (ICVS) is still debated. We conducted a systematic review and meta-analysis with the aim to compare treatment outcomes amongst management strategies (conservative surveillance (CS), microsurgical resection (MR), or stereotactic radiosurgery (SRS)) aiming to inform guideline recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS).
Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2021 referenced in PubMed or Embase. Inclusion criteria were peer-reviewed clinical studies or case series reporting a cohort of ICVS managed with CS, MR, or SRS. Primary outcome measures included tumor control, the need for additional treatment, hearing outcomes, and posttreatment neurological deficits. These were pooled using meta-analytical techniques and compared using meta-regression with random effect.
Forty studies were included (2371 patients). The weighted pooled estimates for tumor control were 96% and 65% in SRS and CS series, respectively (P < .001). Need for further treatment was reported in 1%, 2%, and 25% for SRS, MR, and CS, respectively (P = .001). Hearing preservation was reported in 67%, 68%, and 55% for SRS, MR, and CS, respectively (P = .21). Persistent facial nerve deficit was reported in 0.1% and 10% for SRS and MR series, respectively (P = .01).
SRS is a noninvasive treatment with at least equivalent rates of tumor control and hearing preservation as compared to MR, with the caveat of better facial nerve preservation. As compared to CS, upfront SRS is an effective treatment in achieving tumor control with similar rates of hearing preservation.