Hana Hallak, Ramin A Morshed, Alex Pais, Ashley R Metzler, Jason P Sheehan, Varun R Kshettry, Jamie J Van Gompel, Michael J Link, Maria Peris-Celda
{"title":"显微外科切除术与立体定向放射外科手术治疗三叉神经节束瘤：949 例患者治疗结果的 Meta 分析。","authors":"Hana Hallak, Ramin A Morshed, Alex Pais, Ashley R Metzler, Jason P Sheehan, Varun R Kshettry, Jamie J Van Gompel, Michael J Link, Maria Peris-Celda","doi":"10.1227/neu.0000000000003391","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Schwannomas are benign, slow-growing peripheral nerve sheath tumors. Approximately 8% of intracranial schwannomas originate from the trigeminal nerve. No consensus exists regarding superiority of outcomes after resection vs stereotactic radiosurgery (SRS) in the treatment of trigeminal schwannomas (TS). The aim of this study was to compare the efficacy and outcomes of resection vs SRS for TS management.</p><p><strong>Methods: </strong>Embase, PubMed, and SCOPUS databases were queried from the date of inception to July 2023 for primary data reporting TS treatment outcomes after SRS or resection. Risk of bias was reported under Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Overall, 29 retrospective observational studies comprising 949 patients were included in the analysis. A total of 13 studies (n = 589) reported outcomes after SRS, and 16 studies (n = 360) reported outcomes after surgical resection, and 182 patients in the SRS group had previous resection. To ensure statistical validity of comparing the cohorts, 3 checkpoints were assessed: the median age (SRS: 48 vs surgery: 40 years old, P < .01), tumor volume (5.2 vs 8.9 cm3, P = .06), and median follow-up (53.9 vs 48.5 months, P = .59), which reflected the choice of treatment. Compared with surgical resection, the SRS group demonstrated significantly higher rates of facial hypesthesia improvement (44% vs 12%, P < .01) and lower rates of new onset (4% vs 15%, P = .051) at last follow-up. Facial pain was less likely to improve (58% vs 81%, P = .024) after SRS compared with surgery. However, worsened (5% vs 1%, P = .71) and new facial pain (2% vs 1%, P = .55) were comparable between cohorts.</p><p><strong>Conclusion: </strong>SRS seems to offer improvement in rates of hypesthesia and trigeminal motor deficits compared with surgical resection for TS. However, facial pain improvement was more favorable after surgery. These findings highlight the importance of individualized treatment decisions based on patient characteristics, tumor profile, and pretreatment symptoms.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Microsurgical Resection Versus Stereotactic Radiosurgery for Trigeminal Schwannoma: A Meta-Analysis of 949 Patient Treatment Outcomes.\",\"authors\":\"Hana Hallak, Ramin A Morshed, Alex Pais, Ashley R Metzler, Jason P Sheehan, Varun R Kshettry, Jamie J Van Gompel, Michael J Link, Maria Peris-Celda\",\"doi\":\"10.1227/neu.0000000000003391\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Schwannomas are benign, slow-growing peripheral nerve sheath tumors. Approximately 8% of intracranial schwannomas originate from the trigeminal nerve. No consensus exists regarding superiority of outcomes after resection vs stereotactic radiosurgery (SRS) in the treatment of trigeminal schwannomas (TS). The aim of this study was to compare the efficacy and outcomes of resection vs SRS for TS management.</p><p><strong>Methods: </strong>Embase, PubMed, and SCOPUS databases were queried from the date of inception to July 2023 for primary data reporting TS treatment outcomes after SRS or resection. Risk of bias was reported under Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Overall, 29 retrospective observational studies comprising 949 patients were included in the analysis. A total of 13 studies (n = 589) reported outcomes after SRS, and 16 studies (n = 360) reported outcomes after surgical resection, and 182 patients in the SRS group had previous resection. To ensure statistical validity of comparing the cohorts, 3 checkpoints were assessed: the median age (SRS: 48 vs surgery: 40 years old, P < .01), tumor volume (5.2 vs 8.9 cm3, P = .06), and median follow-up (53.9 vs 48.5 months, P = .59), which reflected the choice of treatment. Compared with surgical resection, the SRS group demonstrated significantly higher rates of facial hypesthesia improvement (44% vs 12%, P < .01) and lower rates of new onset (4% vs 15%, P = .051) at last follow-up. Facial pain was less likely to improve (58% vs 81%, P = .024) after SRS compared with surgery. However, worsened (5% vs 1%, P = .71) and new facial pain (2% vs 1%, P = .55) were comparable between cohorts.</p><p><strong>Conclusion: </strong>SRS seems to offer improvement in rates of hypesthesia and trigeminal motor deficits compared with surgical resection for TS. However, facial pain improvement was more favorable after surgery. These findings highlight the importance of individualized treatment decisions based on patient characteristics, tumor profile, and pretreatment symptoms.</p>\",\"PeriodicalId\":19276,\"journal\":{\"name\":\"Neurosurgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-03-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1227/neu.0000000000003391\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/neu.0000000000003391","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：裂神经瘤是一种良性、生长缓慢的周围神经鞘瘤。约有 8% 的颅内分裂瘤起源于三叉神经。在治疗三叉神经裂孔瘤（TS）方面，切除术与立体定向放射手术（SRS）的疗效优劣尚未达成共识。本研究的目的是比较切除术与立体定向放射手术治疗 TS 的疗效和结果：方法：在Embase、PubMed和SCOPUS数据库中查询了从开始日期到2023年7月报告SRS或切除术后TS治疗效果的主要数据。根据纽卡斯尔-渥太华量表报告了偏倚风险：共有 29 项回顾性观察研究纳入分析，其中包括 949 名患者。共有13项研究（n = 589）报告了SRS治疗后的结果，16项研究（n = 360）报告了手术切除后的结果，SRS组中有182名患者曾接受过手术切除。为了确保比较队列的统计有效性，我们评估了 3 个检查点：中位年龄（SRS：48 岁 vs 手术：40 岁，P < .01）、肿瘤体积（5.2 vs 8.9 cm3，P = .06）和中位随访时间（53.9 vs 48.5 个月，P = .59），这反映了治疗方法的选择。与手术切除相比，SRS 组面部感觉减退的改善率明显更高（44% vs 12%，P < .01），最后随访时新发病率更低（4% vs 15%，P = .051）。与手术相比，SRS 后面部疼痛改善的可能性较低（58% 对 81%，P = .024）。然而，两组患者的面部疼痛恶化率（5% vs 1%，P = .71）和新出现的面部疼痛率（2% vs 1%，P = .55）相当：结论：与手术切除相比，SRS 似乎能改善 TS 的感觉减退率和三叉神经运动障碍。结论：与手术切除治疗 TS 相比，SRS 似乎能改善感觉减退和三叉神经运动障碍的发生率，但手术后面部疼痛的改善更为理想。这些发现强调了根据患者特征、肿瘤概况和治疗前症状做出个体化治疗决定的重要性。
Microsurgical Resection Versus Stereotactic Radiosurgery for Trigeminal Schwannoma: A Meta-Analysis of 949 Patient Treatment Outcomes.
Background and objectives: Schwannomas are benign, slow-growing peripheral nerve sheath tumors. Approximately 8% of intracranial schwannomas originate from the trigeminal nerve. No consensus exists regarding superiority of outcomes after resection vs stereotactic radiosurgery (SRS) in the treatment of trigeminal schwannomas (TS). The aim of this study was to compare the efficacy and outcomes of resection vs SRS for TS management.
Methods: Embase, PubMed, and SCOPUS databases were queried from the date of inception to July 2023 for primary data reporting TS treatment outcomes after SRS or resection. Risk of bias was reported under Newcastle-Ottawa Scale.
Results: Overall, 29 retrospective observational studies comprising 949 patients were included in the analysis. A total of 13 studies (n = 589) reported outcomes after SRS, and 16 studies (n = 360) reported outcomes after surgical resection, and 182 patients in the SRS group had previous resection. To ensure statistical validity of comparing the cohorts, 3 checkpoints were assessed: the median age (SRS: 48 vs surgery: 40 years old, P < .01), tumor volume (5.2 vs 8.9 cm3, P = .06), and median follow-up (53.9 vs 48.5 months, P = .59), which reflected the choice of treatment. Compared with surgical resection, the SRS group demonstrated significantly higher rates of facial hypesthesia improvement (44% vs 12%, P < .01) and lower rates of new onset (4% vs 15%, P = .051) at last follow-up. Facial pain was less likely to improve (58% vs 81%, P = .024) after SRS compared with surgery. However, worsened (5% vs 1%, P = .71) and new facial pain (2% vs 1%, P = .55) were comparable between cohorts.
Conclusion: SRS seems to offer improvement in rates of hypesthesia and trigeminal motor deficits compared with surgical resection for TS. However, facial pain improvement was more favorable after surgery. These findings highlight the importance of individualized treatment decisions based on patient characteristics, tumor profile, and pretreatment symptoms.
期刊介绍：
Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery.
Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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