Rowe J G, Radatz M W R, Walton L, Soanes T, Rodgers J, Kemeny A A
National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, UK.
J Neurol Neurosurg Psychiatry. 2003 Sep;74(9):1288-93. doi: 10.1136/jnnp.74.9.1288.
To evaluate the results of stereotactic radiosurgery treating vestibular schwannomas secondary to type 2 neurofibromatosis.
A retrospective review of 122 type 2 neurofibromatosis vestibular schwannomas consecutively treated in 96 patients. Tumour control was assessed by recourse to surgical intervention, by serial radiological imaging, and by the calculation of relative growth ratios in patients (n=29) habouring untreated contralateral tumours to act as internal controls. Hearing function was assessed with Gardner-Robertson grades and with averaged pure tone audiogram thresholds. Other complications are detailed.
Applying current techniques, eight years after radiosurgery it was estimated that 20% of patients will have undergone surgery for their tumour, 50% will have radiologically controlled tumours, and in 30% there will be some variable concern about tumour control, but up to that time they will have been managed conservatively. Relative growth ratios one and two years after treatment indicate that radiosurgery confers a significant (p=0.01) advantage over the natural history of the disease. Analysis of these ratios beyond two years was precluded by the need to intervene and radiosurgically treat the contralateral control tumours in more than 50% of the cases. This growth control was achieved with 40% of patients retaining their Gardner-Robertson hearing grades three years after treatment, (40% having some deterioration in grade, 20% becoming deaf). Pure tone audiogram results suggest some progressive long term hearing loss, although interpretation of this is difficult. Facial and trigeminal neuropathy occurred in 5% and 2%.
Radiosurgery is a valuable minimally invasive alternative treatment for these tumours. For most patients, it controls growth or defers the need for surgery, or both. There is a price in terms of hearing function, although this may compare favourably with the deafness associated with the natural history of the disease, and with surgery. In deciding on therapy, patients should be aware of this treatment option.
评估立体定向放射外科治疗2型神经纤维瘤病继发前庭神经鞘瘤的效果。
回顾性分析96例患者连续治疗的122例2型神经纤维瘤病前庭神经鞘瘤。通过手术干预、系列影像学检查以及计算有未经治疗的对侧肿瘤患者（n = 29）的相对生长率作为内部对照来评估肿瘤控制情况。采用Gardner-Robertson分级和平均纯音听力图阈值评估听力功能。详细记录其他并发症。
应用当前技术，放射外科治疗8年后估计20%的患者将因肿瘤接受手术，50%的患者肿瘤在影像学上得到控制，30%的患者对肿瘤控制存在不同程度的担忧，但在此之前他们将接受保守治疗。治疗后1年和2年的相对生长率表明，放射外科治疗相对于疾病的自然病程具有显著优势（p = 0.01）。超过50%的病例因需要干预并对侧对照肿瘤进行放射外科治疗，无法对两年后的这些比率进行分析。40%的患者在治疗3年后保持Gardner-Robertson听力分级，（40%的患者分级有所恶化，20%的患者失聪），从而实现了生长控制。纯音听力图结果提示存在一些进行性的长期听力损失，尽管对此的解读较为困难。面部和三叉神经病变的发生率分别为5%和2%。
放射外科是这些肿瘤一种有价值的微创替代治疗方法。对大多数患者而言，它能控制肿瘤生长或推迟手术需求，或两者兼具。听力功能方面会有代价，尽管这可能优于与疾病自然病程及手术相关的耳聋情况。在决定治疗方案时，患者应了解这种治疗选择。
