Unger F, Walch C, Schröttner O, Eustacchio S, Sutter B, Pendl G
Department of Neurosurgery, Karl-Franzens University, Graz, Austria.
Acta Neurochir Suppl. 2002;84:77-83. doi: 10.1007/978-3-7091-6117-3_9.
Radiosurgery is a management approach used to treat patients with vestibular schwannomas. The goals are long-term tumour growth control, maintenance of cranial nerve function and prevention of new deficiencies. We sought to determine long-term outcomes measuring the potential benefits against the neurological risks of primary radiosurgery. Gamma Knife radiosurgery was applied as a treatment modality for 289 patients with vestibular schwannomas from April 1992 to April 2002. The long-term results of 100 patients who underwent radiosurgery were evaluated. 60 patients received a primary treatment, 40 other cases presented with previously performed subtotal microsurgical resection or recurrence of disease (12-96 months, median 39). The median treatment volume was 3.4 ccm and the median dose to the tumour margin was 13 Gy. The median patient follow-up time was 76 months (range 60-120 months). Four tumours progressed after primary radiosurgery. Tumour control rate was 96%. Useful hearing (Gardner-Robertson I/II) was preserved in 16 patients (55%). Clinical neurological improvement occurred in 50%. Adverse effects comprised neurological symptoms (incomplete facial palsy) (House-Brackman II/III) in six cases (four recovered completely), mild transient trigeminal neuropathy in five cases, and morphological changes displaying rapid enlargement of preexisting macrocysts in two patients and tumour growth in two other patients. Microsurgical resection was performed in four cases (4%) and two patients underwent a shunting procedure because of hydrocephalus formation (2%). In patients who had undergone previous microsurgery, no new cranial nerve deficit was observed. Radiosurgery is an effective method for growth control of vestibular schwannomas and is associated with both a low mortality rate and a good quality of life. Accordingly, for the preservation of cranial nerve function radiosurgery is a useful method for the management of properly selected patients and is comparable to microsurgery.
放射外科是一种用于治疗前庭神经鞘瘤患者的治疗方法。其目标是长期控制肿瘤生长、维持颅神经功能并预防新的功能缺陷。我们试图确定长期结果，衡量原发性放射外科治疗相对于神经学风险的潜在益处。1992年4月至2002年4月，伽玛刀放射外科被用作289例前庭神经鞘瘤患者的治疗方式。对100例行放射外科治疗患者的长期结果进行了评估。60例患者接受了初次治疗，另外40例患者曾接受过次全显微手术切除或疾病复发（12 - 96个月，中位时间39个月）。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。患者的中位随访时间为76个月（范围60 - 120个月）。初次放射外科治疗后有4个肿瘤进展。肿瘤控制率为96%。16例患者（55%）保留了有用听力（Gardner - Robertson I/II级）。50%的患者出现临床神经功能改善。不良反应包括6例出现神经症状（不完全性面瘫）（House - Brackman II/III级）（4例完全恢复）、5例轻度短暂性三叉神经病变，以及2例患者出现原有大囊肿迅速增大的形态学改变和另外2例患者肿瘤生长。4例患者（4%）接受了显微手术切除，2例患者因脑积水形成接受了分流手术（2%）。在曾接受过显微手术的患者中，未观察到新的颅神经功能缺损。放射外科是控制前庭神经鞘瘤生长的有效方法，且死亡率低、生活质量良好。因此，对于保留颅神经功能而言，放射外科是管理合适患者的有用方法，与显微手术相当。
