(183) Evaluating Clinical Practice Guidelines for Treating and Managing Vestibular Schwannoma

Introduction: Vestibular Schwannomas (VS) are slow-growing tumors mainly arising from the vestibular component of cranial nerve VIII and are the most common tumor of the cerebellopontine angle. Management options include observation, microsurgical resection, stereotactic radiosurgery, and combinations thereof. We utilized the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument to systematically appraise the quality of clinical practice guidelines (CPGs) for VS treatment and management.

Methods: A literature review for CPGs was performed using Pubmed, Scopus, & EMBASE from inception to October 1, 2022. Four reviewers independently evaluated guidelines using the AGREE II tool. A domain score was generated with a satisfactory threshold being >60%. Intraclass correlation coefficients (ICCs) were calculated to determine reviewer variability using R 4.2.1.

Results: 785 articles were identified, but only seven were evaluated after implementing inclusion and exclusion criteria. 3 CPGs were “high” quality, 3 “average” quality, and 1 “low” quality. “Scope and Purpose” (92.66±8.40) and “Clarity and Presentation” (88.70±14.50) possessed the highest domain scores, while “Applicability” (43.90±27.23) and “Editorial Independence” (51.49±46.33) had the lowest. The level of agreement between reviewers was high, with ICC scores of 0.943-0.99 (excellent).

Conclusions: This appraisal demonstrated an average to high quality for most CPGs regarding VS treatment and management. One guideline fell below the quality and methodologic rigor set forth by the AGREE-II instrument. While these findings suggest most CPGs are at least average quality, there are opportunities for improvement in several domains, particularly in applicability, conflicts of interest, rigor of development, and stakeholder involvement.