ABR in the diagnosis of vestibular schwannomas: A meta-analysis

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• 作者：Paul D. Koors ; MD^a ; Leroy R. Thacker ; PhD^b ; Daniel H. Coelho ; MD^a ; ^{dcoelho@mcvh-vcu.edu}
• 刊名：American Journal of Otolaryngology
• 出版年：2013
• 出版时间：May-June, 2013
• 年：2013
• 卷：34
• 期：3
• 页码：195-204
• 全文大小：909 K

文摘

Purpose

The aim of this study is to rigorously evaluate the role of auditory brainstem response (ABR) testing in the diagnosis of vestibular schwannomas (VS).

Materials and methods

Searches were conducted in multiple online databases, supplemented by hand searches. From the studies chosen for final inclusion, relevant data were extracted and meta-analysis of pooled data was performed.

Results

623 studies were identified from which 43 met inclusion criteria for analysis (1978 to 2009) including 3314 patients. Pooled sensitivity for ABR detection of vestibular schwannomas was 93.4 % (95 % CI 92.6-94.3, P = 0.0000). For tumors less than 1 cm (8 studies, 176 patients) sensitivity was 85.8 % (95 % CI 80.6-90.1, P = 0.0116). For tumors greater than 1 cm (6 studies, 251 patients) pooled sensitivity was 95.6 % (95 % CI 93.1-98.2, P = 0.0660). Sensitivity of ABR to detect extracanalicular tumors was higher than for intracanalicular tumors, though pooled data were not statistically valid. Pooled specificity (8 studies, 2432 patients) was 82.0 % (95 % CI 80.5-83.6, P = 0.0000).

Conclusions

Although MRI remains the gold standard, emerging trends towards more conservative management coupled with limited financial resources may prompt many clinicians to review the role of ABR testing in screening for retrocochlear pathology. In light of the high sensitivity and specificity of ABR testing for VS, we strongly urge its reconsideration as a useful diagnostic tool for patients with clinically suspected VS.