title: Meta-analysis on the clinical outcomes in patients with intralabyrinthine schwannomas: conservative management vs. microsurgery.
abstract: The objective of this review is to compare the symptomatological evolution following conservative management (CM) or microsurgery (MS) in patients with intralabyrinthine schwannomas (ILS). A thorough systematic review of the English and French literature from 1948 to February 2014 was performed using Ovid Medline. An ancestor search was also completed. The major inclusion criterion consisted of a diagnosis of ILS with magnetic resonance imaging. Patients with a classic vestibular schwannoma, cases of incidentaloma during surgery or an autopsy were the main exclusion criteria. Thirty-one studies met our selective criteria. Descriptive data were collected from the articles. Clinical outcomes regarding the hearing loss, tinnitus, vertigo, dizziness and aural fullness were stated as improved, unchanged or worse at the last follow-up. All data were then separated into two different groups according to the management option: CM and MS. The data were analyzed using a Pearson χ (2) test and Fisher's exact test. This meta-analysis suggests that MS has a statistically significant favorable outcome regarding symptom relief compared to CM in patients with ILS suffering from tinnitus, vertigo and dizziness. Hearing level was not compared between treatment groups, as MS leads to anacusis. An indicative bias was the main limitation of this study, as patients suffering from intractable vertigo with moderate-to-severe hearing loss were referred to MS. Therefore, in the presence of a serviceable hearing, we suggest that CM should be the treatment of choice.
authors: Division of Otolaryngology Head and Neck Surgery, Montreal University Hospital Center (CHUM), Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke street east, Montreal, QC, H2L 4M1, Canada.
authors: Émilie
authors: É
authors: Gosselin
authors: Division of Otolaryngology Head and Neck Surgery, Montreal University Hospital Center (CHUM), Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke street east, Montreal, QC, H2L 4M1, Canada.
authors: Anastasios
authors: A
authors: Maniakas
authors: Division of Otolaryngology Head and Neck Surgery, Montreal University Hospital Center (CHUM), Notre-Dame Hospital, University of Montreal, 1560 Sherbrooke street east, Montreal, QC, H2L 4M1, Canada. issam.saliba@umontreal.ca.
authors: Issam
authors: I
authors: Saliba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072700:Conservative Treatment; D003638:Deafness / Q000628:therapy; D004244:Dizziness / Q000628:therapy; D004428:Ear Neoplasms / Q000601:surgery / Q000628:therapy*; D007758:Ear, Inner; D005260:Female; D034381:Hearing Loss / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery / Q000628:therapy*; D014012:Tinnitus / Q000628:therapy; D014717:Vertigo / Q000628:therapy
keywords: Conservative management; Hearing loss; Intracochlear schwannoma; Intralabyrinthine schwannoma; Intravestibular schwannoma; Microsurgery; Tinnitus; Vertigo