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- Title
A Meta-analysis Comparing Outcomes of Microsurgery and Gamma Knife Radiosurgery.
- Authors
Kaylie, David M.; Horgan, Michael J.; Delashaw, Johnny B.; McMenomey, Sean O.
- Abstract
Objectives/Hypothesis Surgery has been the most common treatment for acoustic neuromas, but gamma knife radiosurgery has emerged as a safe and efficacious alternative to microsurgery. This meta-analysis compares the outcomes of the two modalities. Study Design A retrospective MEDLINE search was used to find all surgical and gamma knife studies published from 1990 to 1998 and strict inclusion criteria were applied. Results For tumors less than 4 cm in diameter, there is no difference in hearing preservation ( P = .82) or facial nerve outcome ( P = .2). Surgery on all sized tumors has a significantly lower complication rate than radiosurgery performed on tumors smaller than 4 cm ( P = 3.2 × 10−14). Surgery also has a lower major morbidity rate than gamma knife radiosurgery ( P = 2.4 × 10−14). Tumor control was defined as no tumor recurrence or no tumor re-growth. Surgery has superior tumor control when tumors are totally resected ( P = 9.02 × 10−11). Assuming that all partially resected tumors will recur, surgery still retains a significant advantage over radiosurgery for tumor control ( P = .028). Conclusion Data from these studies date back to the late 1960s and do not completely reflect outcomes using current imaging and procedures. A major difficulty encountered in this study is inconsistent data reporting. Future surgical and radiation reports should use standardized outcomes scales to allow valid statistical comparisons. In addition, long-term results from gamma knife radiosurgery using lower dosimetry have not been reported. Surgery should remain the therapy of choice for acoustic neuromas until tumor control rates can be established.
- Publication
Laryngoscope, 2000, Vol 110, Issue 11, p1850
- ISSN
0023-852X
- Publication type
Article
- DOI
10.1097/00005537-200011000-00016