Comparison of balance outcomes according to treatment modality of vestibular schwannoma

Abstract

Objectives: We sought to compare balance outcomes according to treatment modality of vestibular schwannoma (VS) via a meta-analysis that divided measuring tools of balance outcomes into three categories based on type.Methods: A comprehensive review of the literature from January 1966 to September 2017 was performed, looking for studies about long-term balance outcomes after microsurgery (MS), radiotherapy (RT), or observation for VS. A comprehensive meta-analysis was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and Egger's regression.Results: Among 633 references, 34 were included in the meta-analysis. Perceived dizziness improvement rate was significantly higher in the MS group than in the RT group (odds ratio [OR]: 1.61; 95% confidence interval [CI]: 1.08 to 2.40; P < .05, I 2 = 4.18], but no significant difference was observed between the two groups with regard to validated dizziness questionnaire score (standardized mean difference: 0.04; 95% CI: −0.36 to 0.44; P = .84, I 2 = 69.61) or dizziness or disequilibrium-related symptom incidence rate (OR: 0.91; 95% CI: 0.50 to 1.68; P = .77, I 2 = 0). In a subanalysis conducted within the groups after intervention, the MS group demonstrated a lower vertigo incidence rate (P < .001), and the RT group experienced a significant reduction in validated dizziness questionnaire score (P < .05).Conclusions:Our results indicate that MS should be considered at least equal to RT in regard to resolving long-term dizziness and improving balance outcomes. Furthermore, well-designed studies are necessary to predict balance outcomes after VS treatment and to choose from among possible treatment options.

Disease‐Specific Quality of Life in Vestibular Schwannoma: A National Cross‐sectional Study Comparing Microsurgery, Radiosurgery, and Observation

“…Previous studies have identified dizziness and headache as the primary drivers of overall QOL 12–15 . In a meta‐analysis by Kim et al, 15 preexisting balance symptoms improved after radiotherapy, and incident rates of dizziness or disequilibrium were lower following both radiotherapy and surgery.…”

“…Previous studies have identified dizziness and headache as the primary drivers of overall QOL. [12][13][14][15] In a meta-analysis by Kim et al, 15 preexisting balance symptoms improved after radiotherapy, and incident rates of dizziness or disequilibrium were lower following both radiotherapy and surgery. However, observation was not compared to active treatment in the meta-analysis due to insufficient reports of dizziness-related outcomes in observation groups.…”

Clinical outcomes and toxicity of proton radiotherapy for vestibular schwannomas: a systematic review

“…Hearing loss still occurs in approximately half of the patients after photon radiotherapy, a percentage that continues to increase with longer duration of follow-up [7,[9][10][11][12]. In addition, radiotherapy confers a risk of increased balance disturbance or dizziness, tinnitus, and trigeminal and facial neuropathy [13,14]. Furthermore, the long-term effects of radiotherapy on cognitive functioning are not yet well evaluated, and there is a very small chance of induction of a secondary tumor and sometimes with malignant tumor transformation [9-12, 15, 16].…”

Factors Influencing Personalized Management of Vestibular Schwannoma: A Systematic Review

“…A metanalysis by Kim et al [ 85 ] indicates that both microsurgery and radiotherapy can lead to improvement in balance outcomes in VS patients, therefore there is no significant advantage relative to vestibular symptoms between these therapeutic options. Similarly, a systematic review [ 86 ] showed that overall Dizziness Handicap Inventory (DHI) scores were not statistically influenced by intervention, irrespective of modality (surgery VS sRT).…”