A Meta-Analysis of Surgery and Gamma-Knife Treatment for Acoustic Neuroma Less than Three Centimeters in Diameter_West China Medical Journal

Authors：

QIN Shu , CHENG Xing , RONG Hongtao , ZHANG Qiao ,  HUI Xuhui

Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

HUI Xuhui, Email: qingsihuang1008@163.com

Keywords：

聽神經瘤; 手術; 伽馬刀; Meta分析

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【摘要】　目的　比較手術及伽馬刀治療 lt;3 cm聽神經瘤的優劣。　方法　由2名研究人員分別檢索1990年1月1日—2010年3月31日四川大學網上圖書館CENTRAL、ISI、Medline、Embase、NLM Gateway、CBMdisc等數據庫的相關論文，選擇證據級別最高的文獻，使用Cochrane圖書館提供的RevMan 5.0軟件，對手術和伽馬刀治療小型聽神經瘤在面神經、聽力功能保留的優劣方面進行Meta分析。　結果　共檢索到4篇前瞻性隊列研究，排除2篇。剩余的2篇文獻共納入患者173例，分析發現，在1年隨訪及隨訪結束時，手術治療組與伽馬刀治療組相比，在面神經功能完整保留方面，P值及其95%CI分別為0.64（0.53，0.77）、0.67（0.47，0.96）；在保留有用聽力方面，P值及其95%CI分別為0.08（0.02，0.27）及0.08（0.02，0.28）。　結論　伽馬刀治療 lt;3 cm的聽神經瘤，無論在保留有用聽力還是面神經功能方面均明顯優于手術。
【Abstract】　Objective　 To compare surgery and gamma-knife treatment in treating acoustic neuroma less than 3 cm in diameter through Meta analysis. 　Methods　 Two researchers respectively searched relevant papers from such databases as CENTRAL, ISI, Medline, Embase, NLM Gateway, and CBMdisc posted on the online library of Sichuan University. Papers with the highest-grade evidence were selected, and RevMan 5.0 provided by Cochrane Library was used to compare surgery and gamma-knife treatment in the preservation of patients’ facial nerves and useful hearing through Meta analysis. 　Results　 Four prospective cohort studies were found, two of which were excluded. The remaining two articles were analyzed, and we compared surgery and gamma-knife treatment during the 1-year and the last follow-up period in facial nerve preservation and useful hearing preservation. The P value and 95% CI of the comparison was respectively 0.64 (0.53, 0.77) and 0.67 (0.47, 0.96) for facial nerve preservation, and 0.08 (0.02, 0.27) and 0.08 (0.02, 0.28) for useful hearing preservation. 　Conclusion　 Gamma-knife treatment for acoustic neuroma less than 3 cm in diameter is a much better choice than surgery in preserving hearing and facial nerve function.

Citation： QIN Shu,CHENG Xing,RONG Hongtao,ZHANG Qiao,HUI Xuhui. A Meta-Analysis of Surgery and Gamma-Knife Treatment for Acoustic Neuroma Less than Three Centimeters in Diameter. West China Medical Journal, 2011, 26(5): 679-683. doi: Copy

1.	Nikolopoulos TP, O’Donoghue GM. Acoustic neuroma management: an evidence-based medicine approach[J]. Otol Neurotol, 2002, 23(4): 534-541.
2.	Myrseth E, Moller P, Pedersen PH, et al. Vestibular schwannoma: surgery or gammma knife radiosurgery? A prospective, nonrandomized study[J]. Neurosurgery, 2009, 64(4): 654-663.
3.	Pollock BE, Driscoll CLW, Foote RL, et al. Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotacic radiosurgery[J]. Neurosurgery, 2006, 58(7): 77-85.
4.	Di MS, Akagami R. Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas[J]. Neurosurgery, 2009, 111(4): 855-862.
5.	Regis J, Pellet W. Radiosurgery or microsurgery of vestibular schwannomas?[J]. Cancer Radiotherapie, 1998, 2(2): 191-201.
6.	Pollock BE, Lunsford LD, Kondziolka D, et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery[J]. Neurosurgery, 1995, 36(1): 215-224.
7.	Coelho DH, Roland JT, Rush SA, et al. Small vestibular schwannomas with no hearing: comparison of functional outcomes in stereotactic radiosurgery and microsurgery[J]. Laryngoscope, 2008, 118(6): 1909-1916.
8.	Karpinos M, Teh BS, Zeck O, et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs microsurgery[J]. Int J Radiat Oncol, 2002, 54(5): 1410-1421.
9.	Meyer TA, Canty PA, Wilkinson EP, et al. Small acoustic neuromas: surgical outcomes versus observation or radiation[J]. Otol Neurotol, 2006, 27(3): 380-392.
10.	Myrseth E, Moller P, Pedersen PH, et al. Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery[J]. Neurosurgery, 2005, 56(5): 927-935.
11.	Hasegawa T, Kida Y, Kobayashi T. Long-term outcome in patients with vestibular schwannomas treated using gamma knife: 10-year follow up[J]. Neurosurgery, 2005, 102(4):10-16.
12.	Madjid S, Cordula M. Management of 1 000 vestibular schwannomas (acoustic neuromas): hearing function in 1 000 tumor resections[J]. Neurosurgery, 1997, 40(2): 248-262.

1. 　Nikolopoulos TP, O’Donoghue GM. Acoustic neuroma management: an evidence-based medicine approach[J]. Otol Neurotol, 2002, 23(4): 534-541.
2. 　Myrseth E, Moller P, Pedersen PH, et al. Vestibular schwannoma: surgery or gammma knife radiosurgery? A prospective, nonrandomized study[J]. Neurosurgery, 2009, 64(4): 654-663.
3. 　Pollock BE, Driscoll CLW, Foote RL, et al. Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotacic radiosurgery[J]. Neurosurgery, 2006, 58(7): 77-85.
4. 　Di MS, Akagami R. Prospective comparison of quality of life before and after observation, radiation, or surgery for vestibular schwannomas[J]. Neurosurgery, 2009, 111(4): 855-862.
5. 　Regis J, Pellet W. Radiosurgery or microsurgery of vestibular schwannomas?[J]. Cancer Radiotherapie, 1998, 2(2): 191-201.
6. 　Pollock BE, Lunsford LD, Kondziolka D, et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery[J]. Neurosurgery, 1995, 36(1): 215-224.
7. 　Coelho DH, Roland JT, Rush SA, et al. Small vestibular schwannomas with no hearing: comparison of functional outcomes in stereotactic radiosurgery and microsurgery[J]. Laryngoscope, 2008, 118(6): 1909-1916.
8. 　Karpinos M, Teh BS, Zeck O, et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs microsurgery[J]. Int J Radiat Oncol, 2002, 54(5): 1410-1421.
9. 　Meyer TA, Canty PA, Wilkinson EP, et al. Small acoustic neuromas: surgical outcomes versus observation or radiation[J]. Otol Neurotol, 2006, 27(3): 380-392.
10. 　Myrseth E, Moller P, Pedersen PH, et al. Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery[J]. Neurosurgery, 2005, 56(5): 927-935.
11. 　Hasegawa T, Kida Y, Kobayashi T. Long-term outcome in patients with vestibular schwannomas treated using gamma knife: 10-year follow up[J]. Neurosurgery, 2005, 102(4):10-16.
12. 　Madjid S, Cordula M. Management of 1 000 vestibular schwannomas (acoustic neuromas): hearing function in 1 000 tumor resections[J]. Neurosurgery, 1997, 40(2): 248-262.

West China Medical Journal

A Meta-Analysis of Surgery and Gamma-Knife Treatment for Acoustic Neuroma Less than Three Centimeters in Diameter

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