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Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
STEREOTACTIC AND FUNCTIONAL NEUROSURGERY
Sarmiento J. M., Patel S., Mukherjee D., Patil C. G.
Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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.