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Meta-Analysis
. 2024 Mar 4;26(3):429-443.
doi: 10.1093/neuonc/noad253.

Management of sporadic intracanalicular vestibular schwannomas: A critical review and International Stereotactic Radiosurgery Society (ISRS) practice guidelines

Anne Balossier  1   2 , Arjun Sahgal  3 , Rupesh Kotecha  4 , Laura Fariselli  5 , Alessandra Gorgulho  6 , Marc Levivier  7 , Lijun Ma  8 , Ian Paddick  9 , Bruce E Pollock  10 , Jason P Sheehan  11 , John H Suh  12 , Shoji Yomo  13 , Zhenwei Zhang  14 , Jean Regis  1   2
Affiliations
Meta-Analysis

Management of sporadic intracanalicular vestibular schwannomas: A critical review and International Stereotactic Radiosurgery Society (ISRS) practice guidelines

Anne Balossier et al. Neuro Oncol. .

Abstract

Background: The choice of an appropriate strategy for intracanalicular vestibular schwannoma (ICVS) is still debated. We conducted a systematic review and meta-analysis with the aim to compare treatment outcomes amongst management strategies (conservative surveillance (CS), microsurgical resection (MR), or stereotactic radiosurgery (SRS)) aiming to inform guideline recommendations on behalf of the International Stereotactic Radiosurgery Society (ISRS).

Methods: Using PRISMA guidelines, we reviewed manuscripts published between January 1990 and October 2021 referenced in PubMed or Embase. Inclusion criteria were peer-reviewed clinical studies or case series reporting a cohort of ICVS managed with CS, MR, or SRS. Primary outcome measures included tumor control, the need for additional treatment, hearing outcomes, and posttreatment neurological deficits. These were pooled using meta-analytical techniques and compared using meta-regression with random effect.

Results: Forty studies were included (2371 patients). The weighted pooled estimates for tumor control were 96% and 65% in SRS and CS series, respectively (P < .001). Need for further treatment was reported in 1%, 2%, and 25% for SRS, MR, and CS, respectively (P = .001). Hearing preservation was reported in 67%, 68%, and 55% for SRS, MR, and CS, respectively (P = .21). Persistent facial nerve deficit was reported in 0.1% and 10% for SRS and MR series, respectively (P = .01).

Conclusions: SRS is a noninvasive treatment with at least equivalent rates of tumor control and hearing preservation as compared to MR, with the caveat of better facial nerve preservation. As compared to CS, upfront SRS is an effective treatment in achieving tumor control with similar rates of hearing preservation.

Keywords: conservative surveillance; intracanalicular; microsurgical resection; radiosurgery; vestibular schwannoma.

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Conflict of interest statement

All authors have disclosed their conflicts of interest as follows: A.B. none; A.S. consulting fees from Elekta, Variant Medical Systems & BrainLab, payment for lectures from AstraZeneca, Elekta A.B., Varian, BrainLAB, Seagen, support for the meeting from Elekta, Varian, BrainLAB, society board from International Stereotactic Radiosurgery Society, A.O. Spine Knowledge Forum Tumor and Member to the Elekta M.R. Linac Research Consortium, the Elekta Oligometastases Group and the Elekta Gamma Knife Icon Group; R.K.: consulting fees from Kazia Therapeutics, Elekta A.B., Viewray Inc., Castle Biosciences, NovoCure, payment for lectures from Elekta A.B., Accuray Inc., Novocure Inc., Viewray Inc., Elsevier Inc., BrainLab, Peerview Institute for Medical Education, Ion Beam Applications, Monitoring Board from Viewray Medical Advisory Board, G.T. Medical Technologies Data Safety Monitoring Board, Insightec Ltd, Plus Therapeutics, Inc; L.F. none; A.G. none; M.L. none; L.M. none; I.P.: consulting fees from Elekta Instruments, payment for lectures from Elekta Instruments, Variant Medical Systems & Zap Surgical; B.P. none; J.P.S.: consulting fees from Philps & Novocure, support for meeting from Novocure, board society for Neutron Therapeutics, EmpNia & International Radiosurgery Research Foundation; J.H.S. officer in ISRS; Z.Z. none; S.Y. none, J.R.: president elect of the WSSFN, secretary of the ESSFN.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram with study selection details. Studies included in qualitative synthesis correspond to peer-reviewed clinical studies or case series of ICVS treated by MR, SRS, or CS. Studies included in quantitative synthesis correspond to the subset of those at least reporting tumor control, need for further treatment, hearing outcome, or facial nerve deficit; different subsets have been used for meta-analyses focusing on each topic based on available respective rates.
Figure 2.
Figure 2.
Tumor control rates after SRS or CS for ICVS. Tumor control at the last follow-up was achieved in 96% and 65%, respectively, with statistically significant (P < .001) higher rates of tumor control for SRS.
See this image and copyright information in PMC

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