Unger F, Walch C, Papaefthymiou G, Feichtinger K, Trummer M, Pendl G
Department of Neurosurgery, Karl-Franzens University, Graz, Austria.
Acta Neurochir (Wien). 2002 Jul;144(7):671-6; discussion 676-7. doi: 10.1007/s00701-002-0950-5.
Radiosurgery is either a primary or an adjunctive management approach used to treat patients with vestibular schwannomas. We sought to determine outcomes measuring the potential benefits against the neurological risks in patients who underwent radiosurgery after previous microsurgical subtotal resection or recurrence of the tumour after total resection. Gamma Knife radiosurgery was applied as an adjunctive treatment modality for 86 patients with vestibular schwannomas from April 1992 to August 2001. We evaluated the results of 50 patients who had a follow-up of at least 3.5 years (median 75 months, range 42-114 months). In 16 patients a recurrence of disease was observed after previous total resection. The median treatment volume was 3.4 ccm with a median dose to the tumour margin of 13 Gy. Tumour control rate was 96%. Two tumours progressed after adjunctive radiosurgery. Useful hearing (Gardner-Robertson II) (4 patients (8%)) and residual hearing (Gardner-Roberson III) (10 patients (20%)) remained unchanged in all patients, who presented with it before radiosurgery, respectively. Clinical neurological improvement was observed in 24 patients (46%). Adverse effects comprised transient neurological symptoms and signs (incomplete facial palsy, House-Brackman II/III) in five cases (recovered completely), mild trigeminal neuropathy in four cases, and morphological changes displaying rapid enlargement of a pre-existing macrocyst in one patient and tumour growth in another one. No permanent new cranial nerve deficit was observed. Radiosurgery appears to be an effective adjunctive method for growth control of vestibular schwannomas and is associated with both a low mortality rate and a good quality of life. Accordingly, radiosurgery is a rewarding therapeutic approach for the preservation of cranial nerve function in the management of patients with vestibular schwannoma in whom prior microsurgical resection failed.
放射外科手术是用于治疗前庭神经鞘瘤患者的主要或辅助治疗方法。我们试图确定在先前接受显微手术次全切除或肿瘤全切除后复发的患者中，衡量放射外科手术潜在益处与神经学风险的结果。1992年4月至2001年8月，伽玛刀放射外科手术被用作86例前庭神经鞘瘤患者的辅助治疗方式。我们评估了50例随访至少3.5年（中位时间75个月，范围42 - 114个月）患者的结果。16例患者在先前肿瘤全切除后出现疾病复发。中位治疗体积为3.4立方厘米，肿瘤边缘的中位剂量为13 Gy。肿瘤控制率为96%。辅助放射外科手术后有2个肿瘤进展。所有术前有有用听力（Gardner-Robertson II级）（4例患者（8%））和残余听力（Gardner-Roberson III级）（10例患者（20%））的患者，术后听力分别保持不变。24例患者（46%）出现临床神经功能改善。不良反应包括5例短暂性神经症状和体征（不完全性面瘫，House-Brackman II/III级）（均完全恢复）、4例轻度三叉神经病变，以及1例患者出现原有大囊肿快速增大和另1例患者出现肿瘤生长的形态学改变。未观察到永久性新的脑神经功能缺损。放射外科手术似乎是控制前庭神经鞘瘤生长的有效辅助方法，且死亡率低、生活质量良好。因此，对于先前显微手术切除失败的前庭神经鞘瘤患者，放射外科手术是一种有助于保留脑神经功能的有效治疗方法。
