A systematic review of radiosurgery versus surgery for neurofibromatosis type 2 vestibular schwannomas
Article in Press: Accepted Manuscript
• Lawrance K. Chung BS, Thien P. Nguyen BS, John P. Sheppard MS, Carlito Lagman MD, Stephen Tenn PhD, Percy Lee MD, Tania Kaprealian MD, Robert Chin MD, PhD, Quinton Gopen MD and Isaac Yang MD
World Neurosurgery, Copyright © 2017
Neurofibromatosis type 2 (NF2) is an autosomal dominant disease characterized by bilateral vestibular schwannomas (VS). NF2-associated VS (NF2-VS) are routinely treated with microsurgery; however, stereotactic radiosurgery (SRS) has emerged as an effective alternative in recent decades. To better elucidate the role of SRS in NF2-VS, a systematic review of the literature was conducted to compare outcomes of SRS versus surgery.
PubMed, Web of Science, Scopus, Embase, and Cochrane databases were queried using relevant search terms. Retrospective studies investigating outcomes of NF2-VS patients treated with either SRS or surgery were included. Single patient case reports were excluded. Outcome measures between the SRS and surgery groups were compared using chi-square two-sample tests for equality of proportions on the pooled patient data.
A total of 974 patients (485 SRS, 489 surgery) were identified. The mean 5-year local control rate for SRS was 77.6% and the mean recurrence rate for surgery was 5.3%. The mean hearing and facial nerve preservation rates were 37.5% and 89.5%, respectively, for SRS and 46.9% and 69.9%, respectively, for surgery. Rates of hearing preservation were higher after surgery than SRS (p = 0.006), while rates of facial nerve preservation were higher after SRS than surgery (p < 0.001).
SRS appears to be a safe and effective alternative to surgery for NF2-VS. Although rates of hearing preservation were higher in the surgery cohorts, SRS demonstrated high rates of local control and significantly lower facial nerve complications. Certain patients may therefore benefit more from SRS than surgery.
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