Journal Article

Treatment options for unilateral vestibular schwannoma: a network meta-analysis

Li, Mei, Huo, Xianhao, Zhao, Xu, Liu, Xiaozhuo, Zhang, Yifan, Tian, Jihui

2024

Overview

This study aimed to explore the effect of observation, microsurgery, and radiotherapy for patients with vestibular schwannoma (VS). We searched PubMed, Medline, Embase, Web of Science, and Cochrane library from their establishment to July 31, 2024. 34 non-RCTs and 1 RCT that included 6 interventions were analyzed. We found the MS, and different SRS all had better tumor local control rates. Regarding preserved hearing, the order from the highest to the lowest was FSRT 5 fractions, FSRT 3 fractions, SRS, ConFSRT, Observation, and MS. Regarding improvement in the rate of tinnitus, the order from the highest to the lowest was ConFSRT, FSRT 3 fractions, SRS, Observation, MS, and FSRT 5 fractions. In terms of improving the rate of disequilibrium/vertigo, the order from the highest to the lowest was SRS, Observation, FSRT 3 fractions, FSRT 5 fractions, MS, and ConFSRT. In terms of protection of the trigeminal nerve, the order from the highest to lowest was observation, SRS, ConFSRT, FSRT 3 fractions, FSRT 5 fractions, and MS. Lastly, in terms of protection of the facial nerve, the order from the highest to lowest was SRS, ConFSRT, Observation, FSRT 3 fractions, FSRT 5 fractions, and MS. In patients with VS, MS and radiosurgery showed better local tumor control rates; however, compared with MS, different SRS all provided better protection of nerve function and improved the symptoms of vestibular function and tinnitus, among which the best was SRS. Therefore, in these patients, SRS may be a promising alternative treatment.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acoustic neuroma / Acoustics / Analysis / Audiometry / Biomedical and Life Sciences / Biomedicine / Brain cancer / Cancer Research / Care and treatment / Case reports / Clinical trials / Conventionally fractionated stereotactic radiotherapy / Diagnosis / Facial nerve / Fractionated stereotactic radiotherapy / Health Promotion and Disease Prevention / Humans / Intervention / Magnetic resonance imaging / Medicine/Public Health / Meta-analysis / Microsurgery / Microsurgery - methods / Neuroma, Acoustic - complications / Neuroma, Acoustic - therapy / Oncology / Patient outcomes / Patients / Radiation therapy / Radiosurgery / Radiosurgery - methods / Schwann cells / Stereotactic radiosurgery / Surgery / Surgical Oncology / Systematic Review / Tinnitus / Tinnitus - diagnosis / Tinnitus - etiology / Tinnitus - therapy / Toxicity / Treatment Outcome / Trigeminal nerve / Tumors / Vertigo / Vertigo - diagnosis / Vertigo - etiology / Vertigo - therapy / Vestibular schwannoma / Vestibular system / Watchful Waiting