title: Improving outcomes in patients with vestibular schwannomas: microsurgery versus radiosurgery.
abstract: Vestibular schwannomas (VSs) account for 6% of all intracranial tumors. Historically, VSs have been treated with microsurgery (MS); however, stereotactic radiosurgery (SRS) has emerged as a viable alternative. This review seeks to compare the tumor control rates, functional outcomes, and costs associated with these two modalities. A focused review of the published literature (1966-2012) was conducted comparing outcomes between MS and SRS in those with VS. Outcomes of interest included hearing preservation, facial nerve preservation, tumor control, and cost-effectiveness. Three level 2 studies, eight level 3 studies, and several level 4 studies were reviewed and assessed. Evidence from level 2 studies show that SRS (40-68%) results in higher rates of serviceable hearing compared to MS (0-5%), and higher rates of facial nerve preservation are likewise seen after SRS (98-100%) compared to MS (66-83%) in patients with tumors <3 cm in size. Complications vary as expected by treatment modality, with CSF leak, tinnitus, and trigeminal symptoms being among the most common complications following MS. Hydrocephalus, tinnitus, and trigeminal symptoms were reported in a small percentage of patients after SRS. Tumor control is comparable between MS and SRS for tumors <3cm in size. Total costs for MS can reach over two times higher than for SRS, although long-term follow-up data is needed. SRS has been shown to be efficacious and have a lower morbidity in most patients with tumors that are <3cm. SRS can be considered as the primary modality of choice for treatment of most VS that are <3cm.
authors.affiliation: Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: D
authors.initials: D
authors.lastname: Mukherjee
authors.forename: C G
authors.initials: CG
authors.lastname: Patil
mesh_terms: D019317:Evidence-Based Medicine / Q000639:trends; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects* / Q000592:standards; D009464:Neuroma, Acoustic / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D016634:Radiosurgery / Q000009:adverse effects* / Q000592:standards; D016896:Treatment Outcome