Park Chul-Kee, Jung Hee-Won, Kim Jeong Eun, Son Young-Je, Paek Sun Ha, Kim Dong Gyu
Department of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Chongno-gu, Seoul, Korea.
J Neurooncol. 2006 Apr;77(2):167-71. doi: 10.1007/s11060-005-9015-y.
Management of large vestibular schwannoma (VS) remains a difficult problem for which the extent of tumor resection and the role of radiosurgery continue to be the subject of debate. To develop an optimal therapeutic strategy for large VS, various treatment options within the avenues of microsurgery and radiosurgery were evaluated and compared. The authors carefully reviewed the clinical data of 50 surgical cases of large VS, defined as tumors with an average diameter over 3 cm in magnetic resonance imaging (MRI). All patients underwent microsurgery as the primary treatment. Gross total removal (GTR) was achieved in nine patients (18%), near total removal (NTR) in 8 (16%), radical subtotal removal (R-STR) in 31 (62%), and subtotal removal (STR) in 2 (4%). Among the 33 patients with R-STR and STR, eight had undergone adjuvant radiosurgery for the residual mass. Average tumor volume and diameter were 26.8 cm(3) (13.5-55.1) and 36.4 mm (30.0-47.2), respectively. The mean follow-up duration was 113 months (58-167). The tumor control rate and facial nerve function according to the extent of removal were analyzed. The overall tumor control rate was 82%. Perfect tumor control was achieved after NTR and R-STR with adjuvant radiosurgery. However, 11% (1 of 9) of GTR patients and 32% (8 of 25) of R-STR-only and STR patients showed recurrence or regrowth. Overall favorable outcome of facial nerve function (H-B grade 1 or 2) was achieved in 78% of the patients. The facial nerve preservation rate was inversely proportional to the extent of tumor removal. NTR or R-STR with adjuvant radiosurgery might be acceptable therapeutic options for large VS in terms of achieving good tumor control and functional preservation of facial nerve.
大型前庭神经鞘瘤（VS）的治疗仍然是一个难题，肿瘤切除范围和放射外科手术的作用仍是争论的焦点。为制定大型VS的最佳治疗策略，对显微手术和放射外科手术途径内的各种治疗选择进行了评估和比较。作者仔细回顾了50例大型VS手术病例的临床资料，大型VS定义为磁共振成像（MRI）中平均直径超过3 cm的肿瘤。所有患者均接受显微手术作为主要治疗方法。9例患者（18%）实现了全切（GTR），8例（16%）实现了近全切（NTR），31例（62%）实现了根治性次全切除（R-STR），2例（4%）实现了次全切除（STR）。在33例接受R-STR和STR的患者中，8例因残留肿块接受了辅助性放射外科手术。平均肿瘤体积和直径分别为26.8 cm³（13.5 - 55.1）和36.4 mm（30.0 - 47.2）。平均随访时间为113个月（58 - 167）。分析了根据切除范围的肿瘤控制率和面神经功能。总体肿瘤控制率为82%。NTR和R-STR联合辅助性放射外科手术后实现了完美的肿瘤控制。然而，9例GTR患者中有11%（1例）以及仅接受R-STR和STR的患者中有32%（25例中的8例）出现复发或再生长。78%的患者面神经功能获得了总体良好结果（H-B 1级或2级）。面神经保留率与肿瘤切除范围成反比。就实现良好的肿瘤控制和面神经功能保留而言，NTR或R-STR联合辅助性放射外科手术可能是大型VS可接受的治疗选择。
