Comparison between Microsurgery and Radiosurgery in management of vestibular schwannoma Systematic review

Abstract

Acoustic neuroma, also known as vestibular schwannoma, is a benign tumor arising from Schwann cells, which compromise the myelin sheath of the vestibulocochlear nerve (CN VIII). It usually arises from the vestibular portion of the nerve and can be located inside the internal acoustic meatus or the cerebellopontine angle, or it can have both intracanalicular and cerebellopontine angle components Presently, 3 principal treatment options are available for patients presenting with VS, microsurgery, stereotactic radiation, and conservative management. Depending on tumor size, hearing level, and the patient’s overall physical state, any of the aforementioned approaches are feasible to pursue, with overlapping treatments becoming more common in today’s practice. There are three common surgical approaches for VSs, the middle cranial fossa approach, retrosigmoid (hearing preserving approach) and translabyrinthine (non hearing preserving approach). The choice of surgical approach depends mainly on the size of the tumor and whether preservation of hearing is attempted. Surgery aims to achieve complete excision of the tumor, however radiosurgery induces a vascular necrosis and fibrosis (the tumor is still present after treatment) The best possible management among patients with VS less than 3 cm still remains unclear, larger tumors are treated with microsurgery A meta-analysis study was done To find out which is preferable treatment for Vestibular schwannoma 3 cm or less either Microsurgery or radiosurgery. This was conducted through the following steps: • Target: VSs up to 3 cm in size to know which is better for treatment of such tumors, microsurgery or gamma knife. • Identification and location of articles: the search was done in the Pubmed, we found 25 articles were relevant; from those 5 articles were included and 20 articles were excluded. • Screening and evaluation: according to inclusion criteria 5 articles were included and 20 articles were excluded. • Data collection: data were collected from the included articles.