Regis J, Delsanti Ch, Roche Ph, Soumare O, Dufour H, Porcheron D, Peragut J-C, Thomassin J-M, Pellet W
Service de Neurochirurgie Fonctionnelle et Stéréotaxie, Hôpital d'Adultes de la Timone, 264, rue Saint-Pierre, 13385 Marseille Cedex 05.
Neurochirurgie. 2002 Dec;48(6):471-8.
Preservation of functional hearing can be now attempted during the surgical treatment of a vestibular schwannomas. The probability of functional hearing preservation for each of the neurosurgical approaches is currently under evaluation. We report here a preliminary evaluation of our radiosurgical experience.
In Marseilles, we performed 800 gamma-knife procedures for cochleovestibular schwannomas by between July 1992 and December 2000. These patients were evaluated systematically according to a prospective methodology. We report here the study of the population of 211 patients with unilateral schwannoma and a functional preoperative hearing (Gardner and Robertson 1 or 2) treated as first intention, with a follow-up longer than two years.
Hearing was improved with the radiosurgery in 3% of cases with a average gain of 10 decibels. Average loss in decibel on the four main frequencies (500, 1,000, 2,000, 4,000 Hz) was 17 dB. The probability of functional hearing preservation with radio surgery was high: 73%. However, this probability depended on numerous factors related to the patient and to the "operative technique". The main parameters of predictability were limited preoperative tonal loss, Gardner and Robertson stage 1 (versus 2), multiisocentric planning, peripheral dose lower than 13 Gy. So a Gardner and Robertson stage 1 intracanalicular tumor treated in accordance with "the state of the art" with a gamma-knife and a marginal dose inferior to 13 Gy has a probability of functional conservation at 2 years greater than 95%.
Our results are preliminary and they require the confirmation of a more extensive and more prolonged follow-up. However, the large size of this population and the systematic methodology should help us in determining more precisely the place of radiosurgery and especially to better inform the patients of their chances of hearing preservation according to their individual risk profile.
目前在听神经瘤的外科治疗中可尝试保留功能性听力。目前正在评估每种神经外科手术方法保留功能性听力的可能性。我们在此报告对我们的放射外科治疗经验的初步评估。
1992年7月至2000年12月期间，我们在马赛对800例耳蜗前庭神经鞘瘤患者进行了伽玛刀手术。这些患者按照前瞻性方法进行了系统评估。我们在此报告对211例单侧神经鞘瘤且术前听力功能正常（Gardner和Robertson分级为1或2级）的患者群体的研究，这些患者接受了初次治疗，随访时间超过两年。
放射外科治疗后，3%的病例听力得到改善，平均增益为10分贝。四个主要频率（500、1000、2000、4000赫兹）的平均分贝损失为17分贝。放射外科手术保留功能性听力的概率很高：73%。然而，这一概率取决于许多与患者和“手术技术”相关的因素。可预测性的主要参数包括术前音调损失有限、Gardner和Robertson分级为1级（相对于2级）、多中心规划、周边剂量低于13 Gy。因此，按照“最新技术”使用伽玛刀治疗且边缘剂量低于13 Gy的Gardner和Robertson分级为1级的管内肿瘤，其两年时功能性保留的概率大于95%。
我们的结果是初步的，需要更广泛、更长期的随访来证实。然而，该群体规模较大且采用了系统的方法，这将有助于我们更精确地确定放射外科的地位，特别是能根据患者的个体风险状况更好地告知他们听力保留的机会。
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