AP-HM, Timone Hospital, Functional and Stereotactic Neurosurgery, Marseille, France.
Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.
Neurosurgery. 2023 Jun 1;92(6):1130-1141. doi: 10.1227/neu.0000000000002354. Epub 2023 Feb 3.
Stereotactic radiosurgery (SRS) is one of the main treatment options in the management of small to medium size vestibular schwannomas (VSs), because of high tumor control rate and low cranial nerves morbidity. Series reporting long-term hearing outcome (>3 years) are scarce.
To perform a systematic review of the literature and meta-analysis, with the aim of focusing on long-term hearing preservation after SRS.
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we reviewed articles published between January 1990 and October 2020 and referenced in PubMed or Embase. Inclusion criteria were peer-reviewed clinical study or case series of VSs treated with SRS (single dose), reporting hearing outcome after SRS with a median or mean audiometric follow-up of at least 5 years. Hearing preservation, cranial nerves outcomes, and tumor control were evaluated.
Twenty-three studies were included. Hearing preservation was found in 59.4% of cases (median follow-up 6.7 years, 1409 patients). Main favorable prognostic factors were young age, good hearing status, early treatment after diagnosis, small tumor volume, low marginal irradiation dose, and maximal dose to the cochlea. Tumor control was achieved in 96.1%. Facial nerve deficit and trigeminal neuropathy were found in 1.3% and 3.2% of patients, respectively, both significantly higher in Linear Accelerator series than Gamma Knife series ( P < .05).
Long-term hearing preservation remains one of the main issues after SRS, with a major impact on health-related quality of life. Our meta-analysis suggests that hearing preservation can be achieved in almost 60% of patients after a median follow-up of 6.7 years, irrespective of the technique.
立体定向放射外科（SRS）是治疗小至中型前庭神经鞘瘤（VSs）的主要治疗选择之一，因为它具有较高的肿瘤控制率和较低的颅神经发病率。报告长期听力结果（>3 年）的系列研究很少。
对文献进行系统回顾和荟萃分析，旨在关注 SRS 后的长期听力保护。
使用系统评价和荟萃分析的首选报告项目指南，我们查阅了 1990 年 1 月至 2020 年 10 月期间在 PubMed 或 Embase 上发表的文章，并参考了这些文章。纳入标准为经同行评审的临床研究或 SRS（单次剂量）治疗 VSs 的病例系列报告，SRS 后听力结果报告，中位或平均听力随访时间至少为 5 年。评估听力保护、颅神经结果和肿瘤控制。
共纳入 23 项研究。59.4%的病例（中位随访 6.7 年，1409 例患者）实现了听力保护。主要有利的预后因素包括年龄较小、听力状况良好、诊断后早期治疗、肿瘤体积较小、边缘照射剂量较低和耳蜗最大剂量。96.1%的患者肿瘤得到控制。面神经缺损和三叉神经病变分别在 1.3%和 3.2%的患者中发现，两者在直线加速器系列中均显著高于伽玛刀系列（P<0.05）。
SRS 后长期听力保护仍然是一个主要问题，对健康相关生活质量有重大影响。我们的荟萃分析表明，无论采用何种技术，在中位随访 6.7 年后，近 60%的患者可实现听力保护。
