Hearing preservation and quality of life in small to medium sized vestibular schwannomas after a wait and scan approach or stereotactic radiosurgery: a systematic review and meta-analysis

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-09-09 DOI:10.1007/s00701-024-06249-x

Anderson Brito, Jackson Daniel Sousa Silva, Fernando Terry, Anuraag Punukollu, Adam S. Levy, Anna Lydia Machado Silva, Herwin Speckter, Alexis A. Morell, Alejandro Enriquez-Marulanda, Ziev B. Moses, Ricardo J. Komotar, Rafael A. Vega

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Abstract

Background

The management of vestibular schwannomas (VS) encompasses a choice between conservative “wait-and-scan” (WAS) approach, stereotactic radiosurgery (SRS) or open microsurgical resection. Currently, there is no consensus on the optimal management approach for small to medium sized VS. This study aims to compared outcomes related to hearing in patients with small and medium sized VS who underwent initial treatment with WAS versus SRS.

Methods

A systematic review of the available literature was conducted using PubMed/MEDLINE, Embase, and Cochrane up December 08, 2023. Meta-analysis was performed using a random-effect model to calculate mean difference (MD) and relative risk (RR). A leave-one-out analysis was conducted. The risk of bias was assessed via the Risk of Bias in Non-randomized Studies-Interventions (ROBINS-I) and Cochrane Risk of Bias assessment tool (RoB-2). Ultimately, the certainty of evidence was evaluated using the GRADE assessment. The primary outcomes were serviceable hearing, and pure-tone average (PTA). The secondary outcome was the Penn Acoustic Neuroma Quality of Life Scale (PANQOL) total score.

Results

Nine studies were eligible for inclusion, comprising a total of 1,275 patients. Among these, 674 (52.86%) underwent WAS, while 601 patients (47.14%) received SRS. Follow-up duration ranged from two to eight years. The meta-analysis indicated that WAS had a better outcome for serviceable hearing (0.47; 95% CI: 0.32 – 0.68; p < 0.001), as well as for postoperative functional measures including PTA score (MD 13.48; 95% CI 3.83 – 23.13; p < 0.01), and PANQOL total score (MD 3.83; 95% CI 0.42 – 7.25; p = 0.03). The overall certainty of evidence ranged from “very low” to “moderate”.

Conclusions

Treating small to medium sized VS with WAS increases the likelihood of preserving serviceable hearing and optimized PANQOL overall postoperative score compared to SRS. Nevertheless, the limited availability of literature and the methodological weakness observed in existing studies outline the need for higher-quality studies.

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等待扫描法或立体定向放射外科手术后中小型前庭分裂瘤的听力保持和生活质量：系统综述和荟萃分析。

背景：前庭分裂瘤（VS）的治疗包括在保守的 "等待和扫描"（WAS）方法、立体定向放射外科手术（SRS）或开放式显微外科切除术之间进行选择。本研究旨在比较接受 WAS 与 SRS 初步治疗的中小型 VS 患者的听力相关结果：方法：使用 PubMed/MEDLINE、Embase 和 Cochrane 对截至 2023 年 12 月 8 日的现有文献进行了系统性回顾。采用随机效应模型进行元分析，计算平均差（MD）和相对风险（RR）。进行了 "一出 "分析。偏倚风险通过非随机研究-干预中的偏倚风险（ROBINS-I）和 Cochrane 偏倚风险评估工具（RoB-2）进行评估。最后，采用 GRADE 评估方法对证据的确定性进行评估。主要结果为可用听力和纯音平均值（PTA）。次要结果是宾州听神经瘤生活质量量表（PANQOL）总分：共有 9 项研究符合纳入条件，共纳入 1,275 名患者。其中，674 名患者（52.86%）接受了 WAS 治疗，601 名患者（47.14%）接受了 SRS 治疗。随访时间从两年到八年不等。荟萃分析表明，WAS 对可使用听力的疗效更好（0.47；95% CI：0.32 - 0.68；P 结论：WAS 对可使用听力的疗效更好（0.47；95% CI：0.32 - 0.68；P）：与 SRS 相比，用 WAS 治疗中小型 VS 可增加保留可用听力的可能性，并优化 PANQOL 术后总评分。尽管如此，由于文献资料有限，且现有研究在方法上存在缺陷，因此需要进行更高质量的研究。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.

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