title: How to Address Small- and Medium-Sized Acoustic Neuromas with Hearing: A Systematic Review and Decision Analysis.
abstract: OBJECTIVE
  Small- and medium-sized acoustic neuromas (ANs) increase in both number and proportion. Observation, radiosurgery, and microsurgery are all used to treat this disease; however, the appropriate treatment is controversial, especially in patients with hearing.
  
  
  METHODS
  We searched the MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Con-trolled Trials), LILACS (Latin American and Caribbean Center on Health Sciences Information), and CMB (Chinese Biomedical Database) databases without limits on the language and the time of publication. For the wait-and-scan strategy, we included the population-based prospective studies with sufficient follow-up time and information. We also attempted to locate high-level evidence that compared radiosurgery with microsurgery. The data were extracted from the studies to synthesize the probabilities. We surveyed 60 patients with small- and medium-sized ANs to plot the outcomes on a linear scale to measure the utility.
  
  
  RESULTS
  Eight studies met the inclusion criteria of the wait-and-scan strategy, and 3 grade II evidence studies were found that compared microsurgery with radiosurgery. After synthesizing the data in 3 groups, the preservation of useful hearing was 58.9%, 60.2%, and 4.3%, whereas the rate of tumor control was 71.1%, 97.0%, and 94.3%, respectively. The expected value for radiosurgery was 0.68, whereas the expected values for wait-and-scan and surgery were 0.64 and 0.28, respectively.
  
  
  CONCLUSIONS
  On the basis of the evidence, radiosurgery is the optimal choice for small- and medium-sized ANs. Because of the current difficulty with understanding the natural history of ANs, we suggest that there is a need for new evidence and a health economics assessment to update this result.
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Weiming
authors: W
authors: Liu
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Ming
authors: M
authors: Ni
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Wang
authors: W
authors: Jia
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Dabiao
authors: D
authors: Zhou
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Qing
authors: Q
authors: Zhang
authors: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Yong
authors: Y
authors: Jiang
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: jiaguijun@cssc.net.cn.
authors: Guijun
authors: G
authors: Jia
mesh_terms: D003661:Decision Support Techniques; D003663:Decision Trees; D006309:Hearing; D006801:Humans; D008866:Microsurgery; D009464:Neuroma, Acoustic / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D016634:Radiosurgery
keywords: Acoustic neuromas; Decision analysis; Microsurgery; Observation; Radiosurgery; Systematic review