A Meta‐analysis Comparing Outcomes of Microsurgery and Gamma Knife Radiosurgery

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Abstract
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. 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. 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 x 10(-14)). Surgery also has a lower major morbidity rate than gamma knife radiosurgery (P = 2.4 x 10(-14)). Tumor control was defined as no tumor recurrence or no tumor regrowth. Surgery has superior tumor control when tumors are totally resected (P = 9.02 x 10(-11)). Assuming that all partially resected tumors will recur, surgery still retains a significant advantage over radiosurgery for tumor control (P = .028). 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.