P05.63 The best treatment for Vestibular Schwannoma: Systematic Review of Clinical Trials and Case Series

Abstract Background Vestibular Schwannoma (VS) causes loss of hearing, loss of balance, tinnitus and even may lead to facial numbness. Various treatment choices have been increasing such as surgery, fractionated stereotactic radiotherapy (FSRT), Gamma Knife radiosurgery (GKRS), single fraction linac stereotactic radiosurgery (SFSRT) and conservative treatment. However, there is no conclusive evidence about the best treatment of VS. In this study, we aimed to systematically review and meta-analyze all possible strategies for management of VS. Material and Methods We conducted a systematic electronic search in 13 electronic databases; PubMed, ScienceDirect, WHO Global Health Library, Virtual Health Library (VHL), Scopus, The Institute of Science Index (ISI), Google Scholar, Clinical trials, Controlled Trials (MRCT), Cochrane, System for Information on Grey Literature in Europe (SIGLE), EMBASE, New York Academy of Medicine Grey Literature Report (NYAM) database for relevant studies. Original studies and case series reporting treatment of VS were included. Meta-analysis with random effects models was performed for the outcomes of tumor size reduction, increase in hearing capability, and complications. Results We included 48 studies including 3531 participants. The pooled proportions and 95% confidence intervals (95%-CIs) for tumor size reduction using FSRT and GKRS were 0.34 (0.20; 0.51) and 0.53 (0.40; 0.65), respectively. The proportions and 95%-CÍs of increase in hearing capability using surgery, FSRT, and GKRS were 0.11 (0.0; 0.91); 0.08 (0.05; 0.11), and 0.08 (0.05; 0.13), respectively. The pooled proportions of complications of surgery, FSRT, GKRS, and SFSRT were 0.18 (0.10; 0.30); 0.15 (0.08; 0.24); 0.21 (0.14; 0.30); and 0.32 (0.12; 0.24), respectively. Conclusion Our study highlights the efficacy and safety of different treatments for VS such as surgery, FSRT, GKRS, and SFSRT. However, there are no controlled trials to compare these different remedies. Future large scale randomized controlled trials are needed to clarify.