Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA.
Am J Otolaryngol. 2013 May-Jun;34(3):195-204. doi: 10.1016/j.amjoto.2012.11.011. Epub 2013 Jan 14.
The aim of this study is to rigorously evaluate the role of auditory brainstem response (ABR) testing in the diagnosis of vestibular schwannomas (VS).
Searches were conducted in multiple online databases, supplemented by hand searches. From the studies chosen for final inclusion, relevant data were extracted and meta-analysis of pooled data was performed.
623 studies were identified from which 43 met inclusion criteria for analysis (1978 to 2009) including 3314 patients. Pooled sensitivity for ABR detection of vestibular schwannomas was 93.4% (95% CI 92.6-94.3, P=0.0000). For tumors less than 1cm (8 studies, 176 patients) sensitivity was 85.8% (95% CI 80.6-90.1, P=0.0116). For tumors greater than 1cm (6 studies, 251 patients) pooled sensitivity was 95.6% (95% CI 93.1-98.2, P=0.0660). Sensitivity of ABR to detect extracanalicular tumors was higher than for intracanalicular tumors, though pooled data were not statistically valid. Pooled specificity (8 studies, 2432 patients) was 82.0% (95% CI 80.5-83.6, P=0.0000).
Although MRI remains the gold standard, emerging trends towards more conservative management coupled with limited financial resources may prompt many clinicians to review the role of ABR testing in screening for retrocochlear pathology. In light of the high sensitivity and specificity of ABR testing for VS, we strongly urge its reconsideration as a useful diagnostic tool for patients with clinically suspected VS.
本研究旨在严格评估听觉脑干反应（ABR）测试在听神经瘤（VS）诊断中的作用。
在多个在线数据库中进行检索，并辅以手工检索。从最终纳入的研究中提取相关数据，并进行汇总数据的荟萃分析。
从 623 项研究中，有 43 项符合分析标准（1978 年至 2009 年），共包括 3314 例患者。ABR 检测听神经瘤的汇总敏感性为 93.4%（95%置信区间 92.6-94.3，P=0.0000）。对于小于 1cm 的肿瘤（8 项研究，176 例患者），敏感性为 85.8%（95%置信区间 80.6-90.1，P=0.0116）。对于大于 1cm 的肿瘤（6 项研究，251 例患者），汇总敏感性为 95.6%（95%置信区间 93.1-98.2，P=0.0660）。ABR 检测管内肿瘤的敏感性高于管外肿瘤，但汇总数据无统计学意义。汇总特异性（8 项研究，2432 例患者）为 82.0%（95%置信区间 80.5-83.6，P=0.0000）。
尽管 MRI 仍是金标准，但越来越多的保守治疗趋势以及有限的财政资源可能促使许多临床医生重新审视 ABR 测试在筛查听神经瘤方面的作用。鉴于 ABR 测试对 VS 的高敏感性和特异性，我们强烈敦促重新考虑将其作为疑似 VS 患者的有用诊断工具。
