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Otology/Neurotology

(267) Influence of Study Selection and PRISMA on Vestibular Schwannoma Management

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio
Disclosure(s):
Mary Morcos, BS: No relevant relationships to disclose.
Jowan Watson, MSci, BS: No relevant relationships to disclose.
James Naples, MD: No relevant relationships to disclose.


Introduction: Multiple Systematic Reviews (SR) have been performed comparing management options in vestibular schwannoma (VS); despite this extensive literature, outcomes among the existing SRs are heterogeneous. We performed a review of systematic reviews to evaluate factors that contribute to outcome heterogeneity among systematic reviews.

Methods: A search of PubMed, Embase, Medline, and Web of Science was performed. All systematic reviews/meta-analyses published after 1995 comparing at least 2 treatment modalities were included. Data including year of publication and the number of studies included in each review, inclusion and exclusion criteria, outcomes reported, and specialties listed as authors were extracted.

Results: A total of 21 studies were included in the final analysis. Of these, 7 studies compared Microsurgery (MS) vs Radiotherapy (RT) and 4 compared all treatment modalities, while all other categories had 3 or less manuscripts. The MS vs RT group varied in outcome, number of studies included (9-32), and number of inclusion/exclusion criteria (2-6 and 1-6 respectively). Inclusion and exclusion criteria had little overlap between different reviews, including different criteria of tumor size to be included within the study. For the MS vs RT cohort, date of publication was inversely related to the number of studies included (R2=.8272) pre-PRISMA guidelines (2015), and positively correlated post-PRISMA guidelines (R2=.9763). Within MS vs RT, 75% of pre-PRSIMA studies recommended radiotherapy, while post-PRISMA studies varied in recommendation. Authorship did not appear to influence outcomes.

Conclusions: Outcomes in VS systematic reviews are variable and heterogenous despite similar cohort groups studied. Inclusion and exclusion number, and content, varied greatly between different SRs. The introduction of PRISMA guidelines impacted the number of studies in each review. The influence of other factors was less clear. Future studies should aim to consider techniques for standardized reporting of VS outcomes in SR and adherence to PRISMA guidelines.