A meta-analysis of surgical treatment for vestibular schwannoma: is hospital volume related to preservation of facial function?
OBJECTIVE
To investigate the relation between hospital volume and preservation ratios of facial function in surgery for vestibular schwannoma.


METHODS
A meta-analysis was conducted on current literature concerning preservation ratios of facial function after surgical resection of vestibular schwannoma. Studies reported by the House-Brackmann grading system for facial function were searched; all studies were published in English in peer-reviewed journals between 1992 and 2007.


METHODS
Articles had to report 1) patients who had surgery for vestibular schwannoma, 2) House-Brackmann grades for facial function, and 3) calendar time and number of procedures.


METHODS
Standard methods for meta-analysis were adapted.


RESULTS
Data were pooled by weighing studies according to their accuracy. Results were sorted for low-, moderate-, and high-volume hospitals. Linear relations were quantified by metaregression analysis (n = 5,560).


CONCLUSIONS
Findings of this meta-analysis suggest that there is a linear relation between hospital volume and preservation ratio of facial function. The concentration of surgical treatment might be a consideration to optimize clinical outcome. Prospective and nationwide registration of surgical results might contribute to more definitive conclusions regarding outcome of vestibular schwannoma surgery.
Hastan
Deniz
D
Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands.
Vandenbroucke
Jan P
JP
van der Mey
Andel G L
AG
D005145:Face / Q000502:physiology*; D020220:Facial Nerve Injuries / Q000209:etiology; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures; D011183:Postoperative Complications; D012042:Registries; D016896:Treatment Outcome