title: Microsurgery versus stereotactic radiation for small vestibular schwannomas: a meta-analysis of patients with more than 5 years' follow-up.
abstract: OBJECTIVE
  To compare the long-term outcome of hearing and tumor outcome of small vestibular schwannomas treated with stereotactic radiation and microsurgery.
  
  
  METHODS
  A thorough search for English-language publications and "in process" articles dating from 1948 to December 2011 was conducted using Ovid MEDLINE.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  The Pearson χ test was our primary statistical analysis.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Otology & Neurotology, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Maniakas
authors.forename: Issam
authors.initials: I
authors.lastname: Saliba
mesh_terms: D000328:Adult; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D005155:Facial Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000209:etiology; D006320:Hearing Tests; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000453:epidemiology