Shin Y J, Fraysse B, Cognard C, Gafsi I, Charlet J P, Berges C, Deguine O, Tremoulet M
Department of Otolaryngology, Hôpital Purpan, Toulouse, France.
Am J Otol. 2000 Nov;21(6):857-62.
The goal of this study was to assess the effectiveness of the conservative management in patients with acoustic neuroma (vestibular schwannoma).
This retrospective study was performed in a university hospital.
Patients were selected for this wait-and-see policy on the basis of age, general condition, audiometric results, tumor size, and patient preference. The study group included 97 patients, 87 of whom had at least two neuroradiologic examinations. The mean age of this population was 63 years (29 to 89 years). The mean length of follow-up of this population was 31 months. Eighty-seven of these patients had at least two radiologic examinations (magnetic resonance imaging or computed tomography). The mean interval between the initial and follow-up radiologic examinations was 15 months.
Tumor size was measured by use of two-dimensional data in all patients. The mean tumor size was 12 mm. The growth rate of the tumor was estimated by comparison of the results of the measurements from the initial and follow-up neuroradiologic examinations.
Of the 97 patients studied, 6 patients required surgery and 6 required radiotherapy. Sixty patients (62%) were still being treated conservatively at the end of the study period. Three patients of 28 who were classified as candidates for hearing preservation surgery lost their candidacy during the observation period. The mean annual tumor growth rate was 1.52 mm/year. The tumor was stable in size in 36% of patients, regressed in 11% of patients, or grew in 53% of patients. The growth patterns of the acoustic neuroma fell into five categories: continuous growth in 15% of patients, negative growth in 5%, growth followed by negative growth in 40%, negative growth followed by growth in 20%, and no variation of tumor size in 20%.
Conservative management of acoustic neuromas carries difficulties: long-term follow-up of the patients and unpredictability of the tumor growth pattern. A reliable and reproducible radiologic method for evaluating tumor size is of great importance.
本研究的目的是评估听神经瘤（前庭神经鞘瘤）患者保守治疗的有效性。
本回顾性研究在一家大学医院进行。
根据年龄、一般状况、听力测试结果、肿瘤大小和患者偏好选择患者采取观察等待策略。研究组包括97例患者，其中87例至少接受了两次神经放射学检查。该人群的平均年龄为63岁（29至89岁）。该人群的平均随访时间为31个月。这些患者中有87例至少接受了两次放射学检查（磁共振成像或计算机断层扫描）。初始和随访放射学检查之间的平均间隔为15个月。
在所有患者中使用二维数据测量肿瘤大小。平均肿瘤大小为12毫米。通过比较初始和随访神经放射学检查的测量结果来估计肿瘤的生长速率。
在研究的97例患者中，6例需要手术，6例需要放疗。60例患者（62%）在研究期结束时仍在接受保守治疗。28例被归类为听力保留手术候选者的患者中有3例在观察期内失去了候选资格。肿瘤的平均年生长速率为1.52毫米/年。36%的患者肿瘤大小稳定，11%的患者肿瘤缩小，53%的患者肿瘤生长。听神经瘤的生长模式分为五类：15%的患者持续生长，5%的患者负生长，40%的患者先生长后负生长，20%的患者先负生长后生长，20%的患者肿瘤大小无变化。
听神经瘤的保守治疗存在困难：患者的长期随访以及肿瘤生长模式的不可预测性。一种可靠且可重复的评估肿瘤大小的放射学方法非常重要。
