Microsurgery versus stereotactic radiation for small vestibular schwannomas: A meta-analysis of patients with more than 5 years' follow-up

OBJECTIVE: To compare the long-term outcome of hearing and tumor outcome of small vestibular schwannomas treated with stereotactic radiation and microsurgery. DATA SOURCES: A thorough search for English-language publications and "in process" articles dating from 1948 to December 2011 was conducted using Ovid MEDLINE. STUDY SELECTION: The principal criteria were patients having had microsurgery or radiation therapy as their sole treatment, with a follow-up of at least 5 years, and a useful hearing level at diagnosis. DATA EXTRACTION: Sixteen studies met our criteria. Hearing preservation outcome (worse or preserved) and tumor outcome (failure, control) data, as well as all other significant observations, were collected from the articles. Stereotactic radiation was the only radiation therapy analyzed. DATA SYNTHESIS: The Pearson χ test was our primary statistical analysis. CONCLUSION: Stereotactic radiation showed significantly better long-term hearing preservation outcome rates than microsurgery (p < 0.001). However, long-term tumor outcome was not significantly different in stereotactic radiation as compared with microsurgery (p = 0.122). Although stereotactic radiation demonstrates a more favorable long-term hearing preservation outcome as compared with microsurgery, additional studies are required to provide the medical field with a better understanding of vestibular schwannoma treatment.