Comparison of balance outcomes according to treatment modality of vestibular schwannoma

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.

Level of Evidence

2a Laryngoscope, 2019

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