Department of Neurological Surgery, University of California, San Francisco, 94143, USA.
J Neurosurg. 2011 Feb;114(2):381-5. doi: 10.3171/2010.4.JNS091962. Epub 2010 May 21.
The authors previously published a systematic review of the English language literature regarding the natural history of untreated vestibular schwannomas (VSs). This analysis found that the best predictor of future hearing loss was tumor growth > 2.5 mm/year on serial imaging, a factor that doubled the rate of hearing loss. In this paper the authors present an analysis of prospectively collected outcomes in patients with untreated VS from their institution that confirms their previous findings.
Clinical, radiographic, and audiometric data for all patients evaluated for VS at the authors' institution over a 22-year period were prospectively collected in a database. All patients in this database who had serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery Grade A or B) on initial presentation were selected, and underwent serial observation. Magnetic resonance imaging and audiometric data were analyzed, and the time from presentation until hearing loss was analyzed using Kaplan-Meier analysis.
Fifty-nine patients with VS who initially presented with serviceable hearing were treated conservatively over this period. Consistent with the authors' previous findings, patients with a tumor growth rate > 2.5 mm/year at any point during follow-up lost their hearing at a much faster rate than those who had slower growing tumors. The median time to hearing loss was 7.0 years in those patients with tumor growth rate > 2.5 mm/year compared to 14.8 years in the other patients (p < 0.0001). The estimated median time to hearing loss in the 3 initial tumor size groups was 11.6 years in the intracanalicular group, 10.3 years in the group with 0.1-1 cm extension into the CPA cistern, and 9.3 years in the group with > 1 cm extension into the CPA cistern (p value nonsignificant). Initial tumor size, age at diagnosis, and neurofibromatosis Type 2 status did not affect the time to loss of serviceable hearing. Interestingly, many patients who were followed up for more than a decade eventually lost their hearing, regardless of whether the tumor displayed any documented interval growth.
The authors confirmed the findings of their systematic review of the literature using a prospectively followed group of patients with untreated VS. Collectively, these data suggest that the expectation for more rapid hearing loss should be communicated to patients, and the decision for surgical or other intervention should be made in the context of the known risk of continued observation of fast growing tumors.
作者先前发表了一篇关于未经治疗的前庭神经鞘瘤（VS）自然史的英文文献系统评价。该分析发现，肿瘤生长> 2.5 毫米/年是预测未来听力损失的最佳指标，这一因素使听力损失的发生率增加了一倍。在本文中，作者分析了来自机构的未经治疗 VS 患者的前瞻性收集结果，证实了他们之前的发现。
作者所在机构在 22 年期间前瞻性地收集了所有接受 VS 评估的患者的临床、影像学和听力数据，并将其纳入数据库。在初始检查时具有可使用听力（美国耳鼻喉头颈外科学会 A 或 B 级）的数据库中所有患者均被选中，并进行了连续观察。分析磁共振成像和听力数据，并使用 Kaplan-Meier 分析从就诊到听力损失的时间。
在此期间，59 例最初表现为可使用听力的 VS 患者接受了保守治疗。与作者之前的发现一致，在随访过程中任何时候肿瘤生长速度> 2.5 毫米/年的患者比肿瘤生长较慢的患者更快地丧失听力。肿瘤生长速度> 2.5 毫米/年的患者中位听力丧失时间为 7.0 年，而其他患者为 14.8 年（p < 0.0001）。在 3 个初始肿瘤大小组中，估计的中位听力丧失时间为管内组 11.6 年，CPA 池内 0.1-1 cm 扩展组 10.3 年，CPA 池内> 1 cm 扩展组 9.3 年（p 值无显著差异）。初始肿瘤大小、诊断时年龄和神经纤维瘤病 2 型状态均不影响可使用听力丧失的时间。有趣的是，许多接受了超过 10 年随访的患者最终都丧失了听力，无论肿瘤是否有任何记录的间隔生长。
作者使用一组未经治疗的 VS 患者前瞻性随访证实了文献系统评价的发现。总的来说，这些数据表明，应向患者传达听力损失更快的预期，并应根据已知的快速生长肿瘤持续观察的风险做出手术或其他干预的决定。
