Madhok Ricky, Kondziolka Douglas, Flickinger John C, Lunsford L Dade
Departments of Neurological Surgery and Radiation Oncology, Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Neurosurgery. 2009 Jun;64(6):1102-5; discussion 1105. doi: 10.1227/01.NEU.0000343743.20297.FB.
Patients who have a schwannoma of the facial nerve (facial schwannoma, facial neuroma) can be managed with observation, surgical resection, stereotactic radiosurgery, or fractionated radiotherapy. Attempted complete resection is associated with facial weakness. The role of radiosurgery in these patients remains to be defined.
We reviewed the clinical and imaging outcomes in patients who underwent gamma knife radiosurgery for a facial schwannoma.
Six patients had radiosurgery and were followed for a mean and median of 46.6 and 61.5 months, respectively (21-85 months). Three had a previous resection, and in 3 the diagnosis was made based on clinical and imaging criteria. All patients had facial nerve symptoms (5 had weakness and 1 had muscle twitching). House-Brackmann grades before radiosurgery were as follows: 1 (n = 1), 2 (n = 3), 3 (n = 1), and 6 (n = 1). The radiosurgery margin dose was 12 or 12.5 Gy. On later imaging, 3 tumors had regressed (with the longest follow-up duration) and 3 were unchanged. All patients had preservation of their preradiosurgery facial function. No other adverse effects were noted and all patients maintained their preradiosurgery level of hearing.
Over a mean of almost 4 years of follow-up, radiosurgery was shown to be a safe and effective management for residual and newly diagnosed facial schwannomas.
患有面神经施万细胞瘤（面神经施万瘤、面神经瘤）的患者可采用观察、手术切除、立体定向放射外科或分次放射治疗。尝试完全切除会导致面部无力。放射外科在这些患者中的作用仍有待确定。
我们回顾了接受伽玛刀放射外科治疗面神经施万瘤患者的临床和影像学结果。
6例患者接受了放射外科治疗，平均随访46.6个月，中位随访61.5个月（21 - 85个月）。3例曾接受过切除手术，3例根据临床和影像学标准确诊。所有患者均有面神经症状（5例有面部无力，1例有肌肉抽搐）。放射外科治疗前的House - Brackmann分级如下：1级（n = 1），2级（n = 3），3级（n = 1），6级（n = 1）。放射外科边缘剂量为12或12.5 Gy。在后续影像学检查中，3个肿瘤缩小（随访时间最长），3个肿瘤无变化。所有患者放射外科治疗前的面部功能均得以保留。未观察到其他不良反应，所有患者听力维持在放射外科治疗前的水平。
经过平均近4年的随访，放射外科被证明是治疗残留和新诊断面神经施万瘤的一种安全有效的方法。
