Antonio Daloiso, Diego Cazzador, Stefano Concheri, Giulia Tealdo, Elisabetta Zanoletti
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引用次数: 0
Abstract
Objective: Hearing loss is a common symptom associated with vestibular schwannoma (VS), either because of the tumor's effects on the cochlear nerve or due to active treatments such as surgery or stereotactic radiosurgery (SRS). Treatment decisions for VS are based on factors including tumor size, hearing status, patient symptoms, and institutional preference. The study aimed to investigate long-term auditory outcomes in VS patients undergoing active treatments with a hearing preservation intent.
Data sources: A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching Scopus, Pubmed, and Web of Science databases from inception to January 2024.
Review methods: Studies meeting inclusion criteria, including a minimum 5-year follow-up and assessment of pre- and posttreatment hearing outcomes, were included. Pooled prevalence estimates for serviceable hearing after SRS and microsurgery were calculated using MetaXL software. Risk of bias assessment was performed with the Risk of Bias in Non-randomized Studies of Interventions tool.
Results: Nine studies met the inclusion criteria, with 356 patients included for analysis. The pooled prevalence of maintaining serviceable hearing after SRS at 10 years was 18.1% (95% confidence interval [CI]: 1.7%-43.3%), with wide prediction intervals indicating variability in outcomes. Microsurgery demonstrated a higher prevalence of maintaining long-term serviceable hearing, with a pooled estimate of 74.5% (95% CI: 63.5%-84.1%).
Conclusion: This systematic review underscores the importance of long-term follow-up in evaluating auditory outcomes in VS treatment. Despite the biases inherent to pretreatment patients selection, hearing preservation microsurgery for sporadic VS removal demonstrated favorable and stable long-term serviceable hearing.
目的：听力下降是前庭分裂瘤（VS）的常见症状，这可能是由于肿瘤对耳蜗神经的影响，也可能是由于手术或立体定向放射手术（SRS）等积极治疗造成的。VS的治疗决定基于肿瘤大小、听力状况、患者症状和机构偏好等因素。该研究旨在调查以保留听力为目的接受积极治疗的 VS 患者的长期听力结果：根据《系统综述和Meta分析首选报告项目》指南进行了系统性文献综述，搜索了Scopus、Pubmed和Web of Science等数据库，搜索时间从开始到2024年1月：符合纳入标准（包括至少 5 年的随访和治疗前后听力结果评估）的研究均被纳入。使用 MetaXL 软件计算了 SRS 和显微手术后可用听力的汇总流行率估计值。使用 "非随机干预研究中的偏倚风险 "工具进行偏倚风险评估：9项研究符合纳入标准，共纳入356名患者进行分析。SRS术后10年听力仍可维持的总体患病率为18.1%（95%置信区间[CI]：1.7%-43.3%），预测区间较宽，表明结果存在变异。显微手术显示出更高的长期听力维持率，汇总估计值为 74.5%（95% 置信区间：63.5%-84.1%）：本系统综述强调了长期随访对评估 VS 治疗听力结果的重要性。尽管治疗前对患者的选择存在固有偏差，但通过听力保护显微手术切除散发性 VS 后，听力保持良好且长期稳定。
期刊介绍：
Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
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