Tschudi D C, Linder T E, Fisch U
Department of Otolaryngology, University Hospital of Zurich, Switzerland.
Am J Otol. 2000 Sep;21(5):722-8.
The aim of this study was to analyze the natural course of unilateral acoustic neuromas and to evaluate the advantages and disadvantages of an initial conservative approach.
Between 1989 and 1994, 74 consecutive patients with the diagnosis of unilateral acoustic neuroma were evaluated at the Department of Otorhinolaryngology, University of Zurich. Their charts and magnetic resonance imaging scans were retrospectively analyzed regarding duration and type of symptoms, initial tumor size, tumor growth pattern, and audiometric data.
Of the 74 tumors, 68.9% (51/74) did not grow during a mean follow-up of 35 months. Eight (16%) of these tumors had radiologically documented tumor regression. Twenty-three tumors did grow, 16 of them (70%) with a growth rate of <2 mm/year. There was a statistically significant correlation between the first-year and the total growth rate, indicating that the tumor's behavior in the first year is highly predictive of its subsequent growth pattern. Patients with progressive hearing loss as a first symptom had a significantly lower tumor growth than those presenting with tinnitus, sudden hearing loss, or dizziness. Patients with tumor growth showed a greater tendency for hearing loss, although this trend was significant only for isolated frequencies. In 12% of the cases (9/74), the initial conservative approach had to be abandoned in favor of surgery.
Watchful expectation can be regarded as a safe approach for selected cases of acoustic neuromas. Surgery or irradiation is indicated in patients with proven growth of their tumors.
本研究旨在分析单侧听神经瘤的自然病程，并评估初始保守治疗方法的优缺点。
1989年至1994年间，苏黎世大学耳鼻喉科对74例连续诊断为单侧听神经瘤的患者进行了评估。对他们的病历和磁共振成像扫描进行回顾性分析，内容包括症状持续时间和类型、初始肿瘤大小、肿瘤生长模式及听力测定数据。
在74个肿瘤中，68.9%（51/74）在平均35个月的随访期间未生长。其中8个（16%）肿瘤经影像学记录有肿瘤缩小。23个肿瘤生长，其中16个（70%）生长速率<2毫米/年。第一年生长速率与总生长速率之间存在统计学显著相关性，表明肿瘤在第一年的行为对其后续生长模式具有高度预测性。以进行性听力损失为首发症状的患者肿瘤生长明显低于以耳鸣、突发性听力损失或头晕为首发症状的患者。肿瘤生长的患者听力损失倾向更大，尽管这种趋势仅在个别频率上具有统计学意义。在12%的病例（9/74）中，不得不放弃初始保守治疗方法而改为手术治疗。
对于部分听神经瘤病例，密切观察可被视为一种安全的方法。对于已证实肿瘤生长的患者，应进行手术或放疗。
